Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2016 to 31 March 2017

Size: px
Start display at page:

Download "Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2016 to 31 March 2017"

Transcription

1 Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2016 to 31 March 2017

2 About Public Health England Public Health England exists to protect and improve the nation s health and wellbeing, and reduce health inequalities. We do this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. We are an executive agency of the Department of Health, and are a distinct delivery organisation with operational autonomy to advise and support government, local authorities and the NHS in a professionally independent manner. Public Health England Wellington House Waterloo Road London SE1 8UG Tel: Facebook: Prepared by: Jonathan Knight, Paul Brand, Peter Willey, Justin van der Merwe For queries relating to this document, contact: EvidenceApplicationTeam@phe.gov.uk Crown copyright 2017 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence, visit OGL or psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Published November 2017 PHE publications gateway number: PHE supports the UN Sustainable Development Goals 2

3 Contents About Public Health England 2 Contents 3 Executive summary 5 1. Background and policy context 9 2. Client classification Assessment of quality and robustness of NDTMS community data Characteristics of clients Substance use profile Age of clients Gender of clients Ethnicity of clients Disability Religion Sexual Orientation Source of referral into treatment (new presentations) Age and presenting substance (new presentations) Injecting behaviour (new presentations) Housing situation (new presentations) Access to services Waiting times for first and subsequent treatment interventions Treatment interventions Engagement Treatment and recovery outcomes Treatment exits and successful completions Six-month outcomes Trends over time Trends in numbers in treatment Trends in age group and presenting substances Trends in club drug and new psychoactive substance (NPS) use Trends in treatment exit reasons Trends in waiting times for first intervention A 12-year treatment population analysis History Relevant web links and contact details Comparability of data to previous reports 63 3

4 9.3 Drug and alcohol treatment collection and reporting timeline Other sources of statistics about drugs Prevalence of drug use Young people Criminal justice statistics International comparisons Drug-related deaths Abbreviations and definitions Abbreviations Definitions 68 Appendix A 72 Diagram to show flow through treatment 72 Appendix B year treatment population 73 4

5 Executive summary Overview This report presents information on individuals (aged 18 and over) who were receiving help in England for problems with drugs and/or alcohol during Many people experience difficulties with, and receive treatment for, both substances. While they may share many similarities they also have clear differences, so this report divides people in treatment into the four substance groups described below. 146,536 Alcohol only 29% Opiate 52% 80,454 24,561 28,242 Non-opiate and alcohol 10% Opiate Non-opiate only Non-opiate and alcohol Alcohol only Non-opiate only 9% Key trends in numbers in treatment and substance use Overall, 279,793 individuals were in contact with drug and alcohol services in ; this is a 3% reduction from the previous year (288,843). The number receiving treatment for alcohol alone decreased the most (5%, 85,035 to 80,454) and the number of alcohol only clients in contact with treatment has fallen by 12% from the 91,651 peak in Estimates of the number of adults with alcohol dependency in England were published for the first time in March The findings from this study suggested that there were 595,131 individuals aged 18 and over drinking at dependent levels and potentially in need of specialist treatment. This is 1.4% of the adult population (95% confidence interval 485,504 to 776,743) Individuals who had presented with a dependency on opiates made up the largest proportion of the total numbers in treatment in (146,536, 52%). This is a fall of 2% since last year. There were 52,803 non-opiate and non-opiate and alcohol clients in contact with treatment in , which was a 2% fall since last year. Despite this overall fall in numbers in treatment for non-opiate substances, the number of individuals presenting with crack cocaine problems (not being used alongside opiates) increased by 23% (2,980 to 3,657), this follows a smaller 5

6 increase of 3% in crack cocaine presentations between and The increase over the last 12 months was seen in nearly all age groups. There was also a 12% increase in individuals presenting with both crack cocaine and opiate problems (19,485 to 21,854), which was seen primarily in those aged 45 and over. Recently published estimates of crack cocaine use in England in reported a 10% increase in the numbers estimated to be using the substance since (166,640 to 182,828 1 ). It is likely that the recent increase in the number of people entering treatment for crack problems reflects the rise in the prevalence of the use of the drug. The increase in the number of new users may be in part caused by changes in the purity and affordability of crack cocaine over the last few years. More information about this can be found in the latest Focal Point report New psychoactive substances and club drugs There were 1,450 individuals presenting with problems with the use of one or more new psychoactive substance (NPS) starting treatment in , which is a 29% decrease on last year (2,042). This fall was mainly driven by a 49% reduction in those aged under 25 presenting with NPS problems over the last 12 months (627 in to 321 in ). Individuals who present to treatment using NPS are more likely to be homeless compared to those not using these substances at the start of treatment (18% vs 7%). There was a 23% fall in the total number of ecstasy presentations over the last year (1,318 to 1,013), with a much larger decrease of 70% recorded in the number starting treatment citing problematic mephedrone use. Smoking Information on the smoking status of individuals starting treatment has been included in this report for the first time. Opiate clients had the highest reported rates of smoking when commencing treatment (59%). This was closely followed by non-opiates, and alcohol and nonopiate users (52% and 49% respectively). Those presenting with problematic alcohol use only had the lowest rates, with 34% smoking at the start of treatment. For all substance groups the rates of smoking at the start of treatment are substantially higher than the national rate of smoking among adults (15.5%) ,640 (95% confidence interval 161, ,706) to 182,828 (95% confidence interval 176, ,782) 2 6

7 Age groups Individuals in treatment for alcohol only and opiate use tend to be older than those who have presented for problems with other substances. The median age of alcohol only problems was 46 years, with 12% (9,274) aged 60 years and older. Opiate clients were younger than alcohol only clients, with a median age of 39. There were 11,657 individuals aged who commenced treatment in , of these, the majority cited problems with cannabis, alcohol or cocaine (6,322-54%, 5,221-45% and 3,113-27% respectively). Overall, the number of under-25s accessing treatment has fallen by 45% since ; this reflects changes in the patterns of drinking and drug use in this age group over the last 11 years. 3 4 However, while the numbers are relatively low, there was a 30% increase in young adults (under 25) entering treatment for crack cocaine problems (not used alongside opiates), an increase from 281 to 364. This is the first year that there has been a rise in crack cocaine presentations in this age group since Gender Males made up 69% of the entire treatment population in The gender split varied depending on the presenting substances. 73% of people using drugs were male compared to 61% presenting with alcohol only. Ethnicity Individuals recorded as white British made up the largest ethnic group in treatment, (85%, 231,949) with a further 5% from other white groups. No other ethnic group made up more than 1% of the total treatment population. Treatment exits/successful completions In total, 127,475 individuals exited the drug and alcohol treatment system in , with 49% (62,500) having successfully completed their treatment free from dependence. This compares to 50% last year. Alcohol only clients had the highest rates of successful treatment exits, with 61% completing treatment successfully, a slight decrease from 62% last year. Non-opiate only clients followed this, with 59% leaving successfully, a decrease from 60% in Opiate clients had the lowest rate of successful exits in at 26%; this was down from 28% last year and a peak of 37% in A large proportion of the opiate users in treatment have entrenched long term drug use, are often in ill health and less likely to have access to the personal and social resources that can aid recovery, such as employment and stable housing

8 These factors result in opiate users being less likely to complete treatment successfully and/or sustain their recovery when compared to users of other drugs and alcohol alone. Deaths The total number of people who died while in contact with treatment services in was 2,680 (1.0% of all individuals in treatment). This is similar to when there were 2,689 deaths in treatment (0.9% of all individuals in treatment). The number of opiate clients who died in treatment increased by 3% over the last year, (1,693 to 1,741) with deaths as a proportion of all opiate clients in treatment increasing slightly from 1.1% to 1.2%. The median age of opiate clients recorded as having died in was 45 and 74% were male. The number of deaths for users of other drugs fell slightly from 179 in to 172 in , a decrease of 4%. Drug use is a significant cause of premature mortality in the UK. 5 In England, the number of deaths from drug misuse registered in 2016 increased by 3.6% to 2,383, this follows larger increases of 8.5% between 2014 and 2015 and 17.0% between 2013 and The number of registered heroin deaths increased by 0.7% between 2015 and 2016 (1,201 to 1,209) and are the highest on record. Treatment has been demonstrated to provide some protection against drug related deaths and these numbers would likely be even higher without the harm reduction it provides. There were 767 deaths in among individuals accessing treatment for alcohol problems only, which was a 6% decrease on the previous year. Deaths as a proportion of all people in treatment for alcohol only was 1%, which is the same as last year. The median age of these deaths was 50, with 63% being male. 5 Murray, CJ, Richards, MA, Newton, JN, Fenton, KA, Anderson, HR, Atkinson, C,... & Davis, A (2013). UK health performance: findings of the Global Burden of Disease Study The Lancet, 381(9871),

9 1. Background and policy context This report is intended for anyone wishing to understand the availability and effectiveness of structured alcohol and drug treatment in England and the profile of individuals accessing treatment. The report presents statistics submitted by services delivering structured substance misuse interventions. These services are vital components of local authority treatment and recovery systems and the interventions they deliver can improve the lives of individuals, the life chances of their children and the stability of their communities. They also have a significant impact in reducing drug and alcohol-related ill health and death, the spread of blood-borne viruses and in reducing crime. The harmful effects of alcohol and drugs are greater in poorer communities and effective treatment services can play an important role in addressing these inequalities. The statistics in this publication come from analysis of the National Drug Treatment Monitoring System (NDTMS), which collects data on treatment delivery from approximately 900 sites, covering every local authority in England. Treatment centres returning data to NDTMS include community-based and specialist outpatient drug and alcohol services, GP surgeries and hospitals, as well as residential rehabilitation centres and other inpatient units. Information is collected on the demographics and personal circumstances of those receiving treatment as well as details of the interventions delivered to them and associated outcomes. This information is analysed centrally and reported as aggregated statistics. Information on the history of specialist drug and alcohol treatment data collection can be found in chapter nine of this report. While this report focuses on the national picture, NDTMS is an operational database whose principal function lies in supporting the delivery of effective treatment services at a local level. To this end, information from NDTMS is regularly fed back to service commissioners and providers in the form of benchmarked reports, toolkits and data packs to inform local planning and service commissioning. The commissioning support pack is published here: Information on the total number of people in alcohol and drug treatment in each local authority in England, the number commencing it each year, and the number leaving treatment can be found at: NDTMS collects data about treatment for licit and illicit drugs use, as well as for alcohol treatment. Many of those seeking help from the treatment system will have experienced problems with a combination of substances in their lives and will often require treatment to address underlying issues of dependence that are not specific to their use of any one substance. Alcohol in particular is often cited as problematic in combination with illicit drugs by treatment seekers. In recognition of this, and to reflect a growing practice among local 9

10 authorities to commission combined services, the reporting of drug and alcohol treatment is brought together, continuing the approach taken in recent years. Earlier this year the Home Office published the government s updated drug strategy which builds on the 2010 strategy, aiming to do more to address the complex and evolving challenges of drug misuse, including changing drugs markets and patterns of use, the recent increases in the rate of drug-related deaths and the needs of an ageing cohort of heroin and crack users with increasingly poor physical and mental health. The strategy s primary aims are to reduce all illicit and other harmful drug use, and increase recovery rates from drug dependence. This includes PHE taking forwards a randomised controlled trial of the individual placement and support (IPS) approach to employment support for people in drug and alcohol treatment. It was one of the key recommendations in Dame Carol Black s December 2016 report, An independent review into the impact on employment outcomes of drug or alcohol addiction, and obesity. To coincide with the release of the drug strategy, the Department of Health published the PHEsupported update of the 2007 UK-wide clinical guidelines for the treatment of drug misuse and dependence. The new guidelines endorse much of the previous guidelines but there is a stronger emphasis on a holistic approach to the issues and interventions that can support recovery. PHE also published its evidence review on the outcomes that can be expected of drug misuse treatment in England. The review found that good progress has been made in reducing drugrelated harm and promoting recovery through the widespread implementation of evidencebased drug treatment, and that national and local government should build on these benefits. Drug-related deaths (DRDs) have risen significantly in recent years, with heroin deaths doubling from 2012 to The numbers of deaths involving cocaine, NPS, gabapentinoids and opioid pain medicines have also risen. Anonymously matching data from the NDTMS with ONS data provides a better understanding of the causes of some of these deaths and how they can be prevented. This matching was one component of the evidence considered in the PHE 10

11 and the Local Government Association (LGA) supported inquiry into DRDs, whose report was published in September In partnership with drug service providers and others, PHE will be continuing with a programme of work to tackle rises in drug and alcohol-related deaths. We will include a focus on people with alcohol dependency who die during their time in treatment, where numbers have also been increasing. In England in , there were around a million hospital admissions and over 23,000 deaths from alcohol-related conditions including around 8,000 deaths from conditions that are wholly caused by alcohol. 82% of these deaths were from alcohol-related liver disease. Deaths from liver disease in England have increased 400% since Alcohol treatment supports sustained abstinence among dependent drinkers, which is a crucial factor in surviving alcoholrelated liver disease or halting existing damage. PHE published its evidence review on the public health impact of alcohol and the effectiveness of policies for reducing alcohol-related harm in December An abridged version is available in the Lancet. public_health_burden_evidence_review.pdf The review represents England s most comprehensive look at the evidence on the public health burden of alcohol and policy responses to reduce the health, social and economic harm. NHS England s Five Year Forward View for mental health outlines a number of actions for government and arms-length bodies aimed at improving access to care for people with cooccurring mental health and alcohol/drug use conditions. PHE with support from NHS England has published guidance for commissioners and providers across mental health and local authority public health substance misuse services to work in close collaboration to deliver shared outcomes for this group. While the activity covered in this report represents an important part of health and social carefocussed responses to substance misuse in England, it does not represent the entirety of the work. In addition to specialist treatment recorded by NDTMS, there are a range of responses that local areas will wish to have in place to address alcohol and drug misuse effectively. These include: effective use of licensing powers to manage access to alcohol; widespread alcohol identification and brief advice (IBA); hospital alcohol care teams; information and advice on 11

12 reducing harm; needle and syringe programmes, and outreach work. There will also be broader but related support provided to those with alcohol and drug problems such as safeguarding, parenting and family support, access to housing, housing support, employment and training opportunities. Similarly, while these statistics provide information on the numbers of people accessing treatment for their alcohol and/or drug use, they do not give an indication of treatment need or the harms associated with drug and alcohol use. For information on the wider harms associated with alcohol use, the Local Alcohol Profiles for England (LAPE) present a comprehensive picture of the impact of alcohol on health and social harms locally, as well as information on mortality from alcohol-related conditions Estimates of the number of individuals using opiates and/or crack cocaine in reported nationally and by local authority and the estimated number of adults with opiate dependence that have children living in the same household and the number of children in The Crime Survey for England and Wales reports the prevalence of the use of all drugs nationally 12

13 2. Client classification Individuals presenting to adult alcohol and drug treatment services are categorised by the substances they cite as problematic at the start of treatment. They are categorised by the following hierarchal criteria: any mention of opiate use in any episode would result in the client being categorised as an OPIATE client (irrespective of what other substances are cited) clients who present with non-opiate substances (and not opiates or alcohol) will be classified as NON-OPIATE ONLY clients who present with a non-opiate substance and alcohol (but not opiates) recorded in any drug in any episode in their treatment journeys will be classified as NON-OPIATE AND ALCOHOL clients who present with alcohol and no other substances will be categorised as ALCOHOL ONLY This classification method is illustrated in the diagram below. CLIENT ENTERS TREATMENT Has client presented to treatment citing opiates as a problem substance? NO Has client presented to treatment citing nonopiates as a problem substance? NO YES YES Has client presented to treatment citing alcohol as a problem substance? YES NO OPIATE CLIENT NON-OPIATE ONLY CLIENT NON-OPIATE AND ALCOHOL CLIENT ALCOHOL ONLY CLIENT CLIENT CLASSIFICATION 13

14 3. Assessment of quality and robustness of NDTMS community data NDTMS data is routinely collected by PHE. Drug and alcohol treatment providers submit a monthly extract and this is checked for data quality by local NDTMS teams. Data submissions are aggregated and reconciled against previous submissions to create a single national data submission. PHE operates a continual programme of improvement and treatment providers work with their local NDTMS team to improve each monthly submission throughout the year. NDTMS data quality is extremely important as it provides PHE with assurances that the data is an accurate representation of actual activity and it is therefore usable and reliable. It also gives confidence to the user of these statistics that the appropriate checks and balances have been applied. April 2016 saw the introduction of three new variables to the NDTMS dataset: disability, religion, and sexual orientation. The data completeness of these variables is lower than the rest of the dataset (disability 94%, religion 92%, sexual orientation 97%). Data completeness is expected to rise over time for these variables as the reporting process beds in across the treatment system. Table 3.1 provides an overview of the quality of data submitted to NDTMS since The proportion of valid records received out of all submitted records along with the proportion of records received without errors or warnings are included as they indicate the general level of data quality across the broad spectrum of information collected at each monthly data submission. Four additional indicators are also included below that report the proportion of duplicate or overlapping treatment interventions and episodes. These are reported as they provide a sense of how accurate and efficient record keeping is at treatment provider level. A low proportion is desirable as it demonstrates robust administrative functions at a national level. Table 3.1 Data quality of NDTMS Data quality measure Proportion of submitted records that were valid 99.92% 99.99% 99.99% Proportion of records without errors or warnings 99.90% 99.98% 99.90% Proportion of duplicate treatment episodes recorded at the same provider 0.05% 0.03% 0.01% Proportion of overlapping treatment episodes recorded at the same provider 0.05% 0.03% 0.01% Proportion of duplicate treatment interventions recorded at the same provider 0.02% 0.01% 0.02% Proportion of overlapping treatment interventions recorded at the same provider 0.02% 0.01% 0.01% More detailed information on NDTMS data collection and full definitions for the data quality measures recorded in Table 3.1 can be found at: 14

15 In addition to the data quality checks taken at data submission, there are data quality checks and validation rules used in the production of this report. The items in this report range from 100% completion rates to 94%. Where under 100% this is either due to missing data for a client for that item or inconsistent data where there is conflicting information for the same individual. 15

16 4. Characteristics of clients During , NDTMS reported 279,793 individuals aged 18 to 99 in contact with structured treatment. This total includes all individuals in treatment for either problematic drug use, alcohol use or both. Figure 4 below presents how the 279,793 individuals are segmented by the four substance groups used throughout this report. Just over half the clients in contact with treatment during the year (52%) had presented with problematic use of opiates, a further 19% had presented with problems with other drugs and just under a third (29%) had presented with alcohol as the only problematic substance. Figure 4 Numbers in treatment by main substance group ,536 Alcohol only 29% Opiate 52% 80,454 24,561 28,242 Nonopiate and alcohol 10% Opiate Non-opiate only Non-opiate and alcohol Alcohol only Nonopiate only 9% 4.1 Substance use profile Table and figure show the distribution of substances for all individuals in treatment in , by the four substance groups used within this report. Forty three per cent of opiate clients also presented with crack cocaine. The next highest adjunctive substance within this group was alcohol (20%), followed by cannabis (18%) and benzodiazepines (11%). The majority of non-opiate only clients presented to treatment citing cannabis as a problematic substance (60%). The next highest substances cited as problematic were cocaine (33%) and amphetamines (12%). The majority of non-opiate and alcohol clients in contact with treatment in presented citing cannabis (56%), with 44% of clients presenting with cocaine and 8% with amphetamines. Overall, 50% of clients in treatment in presented with problematic alcohol use. Fifty- 16

17 Crack cocaine (not opiate) Cannabis Cocaine Benzodiazepine Amphetamine (other than ecstasy) Other drug Alcohol Opiate (not crack cocaine) Both opiate and crack cocaine Crack cocaine (not opiate) Cannabis Cocaine Benzodiazepine Amphetamine (other than ecstasy) Alcohol Opiate (not crack cocaine) Both opiate and crack cocaine Cannabis Cocaine Benzodiazepine Amphetamine (other than ecstasy) Alcohol Crack cocaine (not opiate) Cannabis Cocaine Benzodiazepine Amphetamine (other than ecstasy) Other drug Hallucinogen Adult substance misuse statistics from NDTMS eight percent of these individuals (80,454) presented with alcohol alone, with the other 42% of individuals (58,152) also reporting problematic use of other substances. Figure Substance breakdown of all clients in treatment % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Opiate 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Non-opiate only Non-opiate and alcohol All clients 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 17

18 Table Substance breakdown of all clients in treatment Substance Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n % n % n % Opiate and/or crack cocaine use Opiate (not crack cocaine) 82,934 57% % ,934 30% Both opiate and crack cocaine 63,602 43% % ,602 23% Crack cocaine (not opiate) - - 2,576 10% 2,662 9% - - 5,238 2% Other drug use Cannabis 26,650 18% 14,631 60% 15,894 56% ,175 20% Cocaine 8,187 6% 8,109 33% 12,537 44% ,833 10% Benzodiazepine 16,103 11% 1,692 7% 1,254 4% ,049 7% Amphetamine (other than ecstasy) 6,341 4% 2,966 12% 2,225 8% ,532 4% Other drug** 1,952 1% 1,111 5% 622 2% - - 3,685 1% Hallucinogen 361 0% 663 3% 328 1% - - 1,352 0% Other prescription drug 448 0% 140 1% 128 0% % Anti-depressant 338 0% 34 0% 54 0% % Solvent 108 0% 104 0% 147 1% % Major tranquiliser 144 0% 30 0% 23 0% % Alcohol Barbiturate 54 0% 6 0% 10 0% % Alcohol 29,910 20% , % 80, % 138,606 50% Total number of individuals * 146, % 24, % 28, % 80, % 279, % *The total number of individuals will be less than the sum of the reported substances as an individual may present with more than one problematic substance **Other drug includes all other substances cited not listed in the table above except for ecstasy and NPS (see table 4.1.2) Percentages may equal 0% or not sum to 100% due to rounding Table presents a breakdown of substances that are categorised under a heading of club drugs and new psychoactive substances (NPS), a collective term for a number of different substances typically used by people in bars and nightclubs, at concerts and parties, before and after a night out. New psychoactive substances citations make up the largest proportion of club drug/nps presentations for all individuals in treatment in (0.9%), with 3.7% of nonopiate only clients citing the substance and 0.7% of opiate clients. As the range of NPS available is large and often changing, NDTMS collects more detailed information on these new substances based on a description of the predominant effect on the user. Out of the NPS citations for individuals in treatment in , most were for NPS that were predominantly cannabinoid (1,369 clients). In total, Ecstasy was cited by 0.7% of all clients in treatment (1,899), with 0.5% citing mephedrone (1,345). 18

19 Table Club drug and new psychoactive substances breakdown of all clients in treatment Club drug and new psychoactive substances Opiate Non-opiate only Non-opiate and alcohol Total n % N % N % n % Mephedrone % % % 1, % New psychoactive substances 1, % % % 2, % Ecstasy % % % 1, % Ketamine % % % 1, % GHB/GBL % % % % Methamphetamine % % % % Further breakdown of new psychoactive substances: Predominantly cannabinoid % % % 1, % Predominantly stimulant % % % % Other % % % % Predominantly sedative/opioid % % % % Predominantly hallucinogenic % % % % Predominantly dissociative 8 0.0% % % % Total number of citations* 2,214 2% 3,598 15% 2,049 7% 7,861 3% Total number of individuals** 2,158 1% 2,958 12% 1,932 7% 7,048 3% Total number in treatment 146, % 24, % 28, % 279, % * This total is for the substances listed in the top part of the table (excluding NPS) plus the individual citations of the NPS substances in the bottom half of the table as clients may have multiple citations for different NPS substances. ** This is a count of individuals as clients may have cited multiple substances in the same treatment journey. Percentages may equal 0% or not sum to 100% due to rounding 4.2 Age of clients The age of individuals at their first point of contact with the treatment system in is reported in table and figure The median age (the middle number in an ascending list of all ages) of non-opiate only clients in treatment in was 30 years, slightly younger than the median age for non-opiate and alcohol clients, at 34 years. Opiate clients were older with a median age of 39 years. This is still younger than the population of England, projected median age 40 years (ONS mid-year population 2016). Alcohol only clients have a median age of 46 years, making them the only group older than the general population. Within this group 69% were aged 40 or over and 12% were 60 years and over. ates/bulletins/annualmidyearpopulationestimates/mid2016 On average individuals are most likely to start using drugs in their late teens and early twenties. The distribution of ages of individuals in treatment reflects patterns seen in estimates of prevalence of drug use, with the latest published estimates for showing a significant 19

20 increase in those aged 35 and over who use opiates rising from 130,628 in to 163,180 in A large proportion of heroin/opiate users in treatment in will have started using heroin in the epidemics of the 1980s and 1990s and are now over 40 years of age, having been using heroin for a significantly long period of time. Those who use other substances tend to be younger, as can be seen in figures 1.2, 1.3 and 1.4 in the Crime Survey for England and Wales. This survey shows that cannabis, ecstasy and powder cocaine are the most commonly used substances for year olds with, for example, 16.4% having used cannabis in the last year (compared to 6.6% for the general population aged 16-59). Table Age of all clients in treatment Age Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n % n % n % % 1,057 4% 751 3% 218 0% 2,171 1% % 878 4% 500 2% 206 0% 1,778 1% ,424 2% 4,781 19% 3,320 12% 2,079 3% 13,604 5% ,797 8% 5,227 21% 4,904 17% 4,967 6% 26,895 10% ,380 17% 4,255 17% 5,067 18% 7,593 9% 41,295 15% ,621 23% 3,140 13% 4,257 15% 9,798 12% 50,816 18% ,825 20% 2,072 8% 3,534 13% 11,947 15% 47,378 17% ,083 15% 1,439 6% 2,882 10% 13,504 17% 39,908 14% ,726 9% 827 3% 1,805 6% 12,267 15% 27,625 10% ,185 4% 387 2% 836 3% 8,601 11% 15,009 5% ,235 2% 180 1% 282 1% 5,021 6% 7,718 3% % 137 1% 67 0% 2,697 3% 3,631 1% % 181 1% 37 0% 1,556 2% 1,965 1% Total 146, % 24, % 28, % 80, % 279, % *Percentages may equal 0% or not sum to 100% due to rounding 20

21 Figure Age distribution of all clients in treatment % 20% 15% 10% 5% 0% Opiate Non-opiate Non-opiate and alcohol Alcohol only 4.3 Gender of clients Table presents the gender distribution for all clients in treatment, segmented by the four substance groups. Overall 31% of individuals in treatment are women, compared to 51% of the population in England. ( mates). The three drug groups opiate, non-opiate only and non-opiate and alcohol have a very similar distribution with about three quarters of each group being male. This is broadly comparable with figures reported in Crime Survey for England and Wales where 11.5% of males aged 16 to 59 had taken an illicit drug in the last year, compared to 5.5% of females. Among those in treatment for alcohol problems only, males made up a lower proportion (61%) than seen in individuals that had presented with drug problems. This differs from the gender prevalence of problematic alcohol and drug use where the rates are similar. Men make up 77% of the estimated alcohol dependent prevalent population. and for opiate users this figure is 76% 21

22 Table Gender of all clients in treatment Male Female Persons n % n % n Opiate 106,766 73% 39,770 27% 146,536 Non-opiate 17,983 73% 6,578 27% 24,561 Non-opiate and alcohol 20,801 73% 7,441 26% 28,242 Alcohol only 48,754 61% 31,700 39% 80,454 Total 194,304 69% 85,489 31% 279, Ethnicity of clients Table reports the ethnicity of clients in treatment in Where reported, most individuals (85%) were white British compared to 80% of the English population, 6 ranging from 86% of alcohol only presentations to 80% of non-opiate only clients. The other white group was the next most common ethnicity, (4%) compared to 5% of the English population. No non-white ethnic group accounted for more than 1% of the total cohort. Within the non-opiate only substance group, 4% of individuals had an ethnicity of Caribbean (71% of whom cited cannabis and 29% cited crack), compared to the English population where the proportion is 1%. 6 For ethnicity data please see: 2011 Census: KS201EW Ethnic group, local authorities in England and Wales calauthoritiesintheunitedkingdom/

23 Table Ethnicity of all clients in treatment Ethnicity Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n % n % n % White British 121,338 85% 19,381 80% 23,137 83% 68,093 86% 231,949 85% Other white 5,784 4% 829 3% 838 3% 3,064 4% 10,515 4% Not stated 1,768 1% 591 2% 556 2% 1,928 2% 4,843 2% White Irish 1,460 1% 191 1% 332 1% 1,237 2% 3,220 1% Indian 1,676 1% 179 1% 247 1% 1,242 2% 3,344 1% Caribbean 1,233 1% 661 3% 507 2% 527 1% 2,928 1% White and black Caribbean 1,293 1% 420 2% 418 2% 387 0% 2,518 1% Pakistani 1,614 1% 363 1% 179 1% 312 0% 2,468 1% Other Asian 1,423 1% 243 1% 147 1% 567 1% 2,380 1% Other 1,243 1% 223 1% 174 1% 457 1% 2,097 1% Other black 795 1% 346 1% 334 1% 388 0% 1,863 1% African 414 0% 347 1% 368 1% 626 1% 1,755 1% Other mixed 695 0% 263 1% 221 1% 324 0% 1,503 1% Bangladeshi 979 1% 148 1% 84 0% 102 0% 1,313 0% White and Asian 418 0% 97 0% 89 0% 137 0% 741 0% White and black African 262 0% 80 0% 107 0% 123 0% 572 0% Chinese 40 0% 9 0% 7 0% 22 0% 78 0% Unknown 2 0% 0 0% 0 0% 0 0% 2 0% Total 142, % 24, % 27, % 79, % 274, % Inconsistent/missing 4, ,704 Total 146,536 24,561 28,242 80, ,793 *Percentages may equal 0% or not sum to 100% due to rounding 4.5 Disability Table reports the disability status of new presentations to treatment. Up to three selfdefined disabilities can be recorded per client. The proportions reported are broadly similar across the four substance groups. Sixty six per cent of all new presentations stated no disability. Behaviour and emotional disability was cited by 8%, while 4% of clients stated mobility and gross motor. The proportion of clients citing at least one disability was 18% this is similar to the most recent census data (2011/12 covering England and Wales) where 18% 4 cited at least one impairment. Disability was introduced to the NDTMS dataset for April Data completeness is expected to improve over time. 4 For disability data please see: 2011 Census: England and Wales. 23

24 Table Disability, new presentations to treatment Non-opiate Non-opiate Opiate Disability only and alcohol Alcohol only Total n % n % n % n % n % Behaviour and 3,393 8% 1,425 8% 1,795 10% 3,827 7% 10,440 8% emotional Hearing 221 1% 93 1% 134 1% 436 1% 884 1% Manual dexterity 205 0% 43 0% 79 0% 287 1% 614 0% Learning disability 740 2% 569 3% 531 3% 871 2% 2,711 2% Mobility and gross motor 1,623 4% 341 2% 459 2% 2,504 5% 4,927 4% Perception of physical 89 0% 28 0% 46 0% 105 0% 268 0% danger Personal, self-care and 179 0% 53 0% 57 0% 255 0% 544 0% continence Progressive conditions 1,273 3% 294 2% 389 2% 1,683 3% 3,639 3% and physical health Sight 264 1% 72 0% 99 1% 394 1% 829 1% Speech 45 0% 18 0% 20 0% 96 0% 179 0% Other 1,207 3% 337 2% 379 2% 1,281 2% 3,204 2% Not stated 5,037 12% 1,711 10% 2,040 11% 5,845 11% 14,633 11% Total citations 14,276 4,984 6,028 17,584 42,872 No disability 29,023 67% 11,114 66% 12,084 65% 34,387 65% 86,608 66% Any disability 7,773 18% 2,784 17% 3,314 18% 9,621 18% 23,492 18% Not stated 4,552 11% 1,541 9% 1,807 10% 5,196 10% 13,096 10% Inconsistent/missing 1,794 4% 1,336 8% 1,511 8% 3,379 6% 8,020 6% Total individuals 43, % 16, % 18, % 52, % 131, % 4.6 Religion Table reports the self-reported religion of new presentations to treatment. Almost half (49%) of clients presenting to treatment during had no religion. The most common religion cited was Christian, reported by nearly a quarter (24%), followed by 2% stating Muslim. Figures from the 2011 census 5 show a higher rate of religious identification among the general population. Christian accounts for 59%, Muslim 5% whilst no religion was at 25% roughly half the rate among NDTMS respondents. The number of inconsistent and missing responses is likely to reduce after the time period as the religion field was only introduced in April For religion data please see: 2011 Census: England and Wales. 24

25 Table Religion, new presentations to treatment Religion Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n n % n % Baha'i 5 0% 1 0% 5 0% 4 0% 15 0% Buddhist 227 1% 68 0% 68 0% 137 0% 500 0% Christian 8,821 22% 2,768 18% 3,498 21% 13,502 28% 28,589 24% Hindu 101 0% 29 0% 52 0% 254 1% 436 0% Jain 8 0% 0 0% 0 0% 2 0% 10 0% Jewish 43 0% 20 0% 22 0% 50 0% 135 0% Muslim 1,256 3% 563 4% 310 2% 449 1% 2,578 2% Pagan 77 0% 29 0% 28 0% 64 0% 198 0% Sikh 345 1% 36 0% 65 0% 416 1% 862 1% Zoroastrian 7 0% 1 0% 0 0% 4 0% 12 0% Other 1,418 4% 524 3% 524 3% 1,638 3% 4,104 3% None 19,685 49% 7,997 53% 9,086 54% 21,949 45% 58,717 49% Decline 2,197 5% 768 5% 1,042 6% 2,892 6% 6,899 6% Unknown 6,034 15% 2,392 16% 2,220 13% 7,059 15% 17,705 15% Total 40, % % 16, % 48, % 120, % Inconsistent/missing 2,918 1,579 1,796 4,163 10,456 Total 43,142 16,775 18,716 52, , Sexual Orientation Table reports the sexual orientation of new presentations to treatment. The table shows that 88% reported being heterosexual, 2% gay/lesbian and 1% bisexual. Using figures from the office for national statistics 6 this can be compared to the general population where the figure for heterosexual is higher (93%) gay/lesbian is lower (1%) and bisexual is similar (1%). Sexual orientation was introduced to the NDTMS dataset for April For sexuality data please see: Sexual identity, UK:

26 Table Sexual orientation, new presentations to treatment Sexual orientation Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n % n % n % Heterosexual 37,702 89% 14,050 88% 15,727 88% 45,203 88% 112,682 88% Gay/Lesbian 631 1% 570 4% 524 3% 1,291 3% 3,016 2% Bi-Sexual 601 1% 295 2% 353 2% 423 1% 1,672 1% Client asked and does not know or is not sure 79 0% 43 0% 44 0% 114 0% 280 0% Not Stated 3,093 7% 920 6% 1,108 6% 3,719 7% 8,840 7% Other 346 1% 157 1% 165 1% 512 1% 1,180 1% Total 42, % 16, % 17, % 51, % 127, % Inconsistent/missing ,546 Total 43,142 16,775 18,716 52, , Source of referral into treatment (new presentations) Table shows a breakdown of new presentations to treatment by source of referral (i.e. the routes by which people accessed treatment). Information about source of referral was provided for 130,666 (99.6%) of all new presentations to treatment in Of all recorded referral sources, self-referrals were the most common for all individuals and across the four substance groups (ranging from 56% for non-opiate only clients to 52% for opiate clients). For alcohol only clients, the next most common referral source was through health services and social care (26%). This was made up of GP referrals (15%), hospital (4%), social services (2%) and other health services (4%). In comparison, health services only accounted for 9% of opiate client referrals. The criminal justice system was the second most common referral source for opiate clients (26%), made up of prison referrals (16%), arrest referrals/dip (5%), probation (3%) and other criminal justice system referral routes (2%). By contrast, only 7% of referrals for alcohol only clients were from the criminal justice system. Particularly high rates of referrals from prison and probation (48%) were seen from clients citing both opiates and NPS at the start of treatment, compared to 19% for opiate clients overall. Overall, substance misuse services accounted for 7% of referrals into treatment (ranging from 3% for non-opiate only clients to 9% for opiate clients). A further breakdown of referral routes into treatment can be found in the supporting tables at 26

27 Table Source of referral into treatment, new presentations to treatment Referral Source Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n % n % n % Self, family and friends Self 22,433 52% 9,297 56% 10,247 55% 28,706 55% 70,683 54% Other family and friends 281 1% 260 2% 246 1% 601 1% 1,388 1% Self, family and friends subtotal 22,714 53% 9,557 57% 10,493 56% 29,307 56% 72,071 55% Health services and social care GP 2,480 6% 1,388 8% 1,852 10% 8,029 15% 13,749 11% Health other 709 2% 699 4% 843 5% 2,293 4% 4,544 3% Hospital 608 1% 163 1% 385 2% 2,322 4% 3,478 3% Social services 208 0% 589 4% 416 2% 1,076 2% 2,289 2% Health services and social care subtotal 4,005 9% 2,839 17% 3,496 19% 13,720 26% 24,060 18% Criminal justice Arrest referral/dip 2,047 5% 884 5% 599 3% 603 1% 4,133 3% Prison 6,880 16% 257 2% 226 1% 296 1% 7,659 6% Probation 1,151 3% 749 4% 889 5% 1,544 3% 4,333 3% Criminal justice other 1,042 2% 597 4% 654 4% 1,099 2% 3,392 3% Criminal justice subtotal 11,120 26% 2,487 15% 2,368 13% 3,542 7% 19,517 15% Substance misuse service Drug service statutory 1,380 3% 183 1% 324 2% 808 2% 2,695 2% Drug service non-statutory 2,344 5% 307 2% 497 3% 1,411 3% 4,559 3% Community alcohol team 81 0% 16 0% 151 1% 1,206 2% 1,454 1% Substance misuse service subtotal 3,805 9% 506 3% 972 5% 3,425 7% 8,708 7% Other 1,216 3% 1,338 8% 1,327 7% 2,429 5% 6,310 5% Total 42, % 16, % 18, % 52, % 130, % Missing or unknown Total 43,142 16,775 18,716 52, ,216 *Percentages may equal 0% or not sum to 100% due to rounding 4.9 Age and presenting substance (new presentations) Table shows the substance distribution for individuals presenting to treatment in , reported by the four substance groups. Overall, 60% (79,202) of individuals starting treatment in presented with problematic alcohol use. Of these, 52,583 cited alcohol as the only problematic substance. Fifty-one per cent of opiate new presentations also presented with crack cocaine, the next highest adjunctive substance alongside opiate use being alcohol (18%). For non-opiate only clients, the majority of individuals cited cannabis as a problematic substance (59%). This was followed by just over a third (36%) of non-opiate only clients presenting with cocaine. 27

28 Cannabis was also the most commonly cited drug that non-opiate and alcohol clients presented with (55%), with cocaine the next most cited substance (47%). Table Substance breakdown of new presentations to treatment Substance Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n % n % n % Opiate and/or crack cocaine use Opiate (not crack cocaine) 21,288 49% ,288 16% Both opiate and crack cocaine 21,854 51% ,854 17% Crack cocaine (not opiate) - - 1,841 11% 1,816 10% - - 3,657 3% Other drug use Cannabis 6,387 15% 9,938 59% 10,290 55% ,615 20% Cocaine 2,111 5% 5,988 36% 8,793 47% ,892 13% Amphetamine (other than ecstasy) 1,353 3% 1,792 11% 1,280 7% - - 4,425 3% Benzodiazepine 3,020 7% 964 6% 740 4% - - 4,724 4% Alcohol Total number of individuals* Other** 508 1% 689 4% 346 2% - - 1,543 1% Alcohol 7,903 18% , % 52, % 79,202 60% 43, % 16, % 18, % 52, % 131, % *The number of individuals will be less than the total of the reported substances as an individual may present with more than one problematic substance **Other includes all other substances not specifically stated in the table above Table and figure report the substance distribution by age for new presentations to treatment in For younger clients presenting to treatment (those aged 18-24), the main substances cited were cannabis (54%, 6,322), alcohol (45%, 5,221) and cocaine (27%, 3,113), with only 17% (2,053) presenting for opiate use. The percentage of individuals presenting with problems with alcohol use increased with age. Sixty one per cent (11,567) of those aged cited alcohol as problematic, with 90% (3,479) of those age doing so. A more detailed breakdown of clients aged can be found in the supporting tables at 28

29 Table Age and presenting substance of new presentations to treatment Substance Total Opiate and/or crack cocaine use Opiate (not crack cocaine) 1,104 2,464 4,059 4,885 3,742 2,591 1, ,288 9% 16% 20% 23% 20% 16% 12% 8% 7% 4% 16% Both opiate and crack cocaine 949 2,750 4,690 5,229 3,876 2,566 1, ,854 8% 17% 23% 24% 20% 15% 10% 5% 3% 1% 17% Crack cocaine (not opiate) ,657 3% 4% 4% 3% 3% 2% 2% 1% 0% 0% 3% Other drug use Cannabis 6,322 4,877 4,552 3,817 2,819 2,181 1, ,615 54% 31% 23% 18% 15% 13% 11% 7% 4% 2% 20% Cocaine 3,113 3,865 3,764 2,768 1, ,892 27% 24% 19% 13% 9% 6% 4% 2% 1% 0% 13% Benzodiazepine ,724 4% 4% 4% 5% 4% 3% 2% 2% 2% 4% 4% Amphetamine (other than ecstasy) ,425 Alcohol Other** Total number of individuals* 4% 4% 4% 4% 4% 3% 2% 1% 1% 0% 3% ,543 2% 2% 1% 1% 1% 1% 1% 1% 1% 2% 1% Alcohol 5,221 7,719 9,846 11,037 11,567 11,644 9,545 6,233 3,479 2,911 79,202 45% 49% 49% 51% 61% 70% 79% 86% 90% 90% 60% 11,657 15,829 20,200 21,574 18,923 16,612 12,112 7,225 3,859 3, ,216 *The number of individuals will be less than the total of the reported substances as an individual may present with more than one problematic substance **Other includes all other substances not specifically stated in the table above Percentages may equal 0% or not sum to 100% due to rounding Figure Age and presenting substance distribution of new presentations to treatment % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Total Opiate and/or crack cocaine Cannabis Cocaine Alcohol 29

30 4.10 Injecting behaviour (new presentations) Injecting status at presentation to treatment was recorded for 129,323 individuals (99%) who entered treatment in The majority of individuals presenting to treatment have never injected (76%), though there was variation by substance with 97% of alcohol only clients having never injected any substance compared to 40% of opiate clients. Just over a quarter (26%) of individuals using opiates were currently injecting, compared to 3% and 1% in the non-opiate only and non-opiate and alcohol clients respectively. The majority of non-opiate clients who inject are likely to be individuals using amphetamines and mephedrone. Sharing of injecting equipment is the single biggest factor in blood-borne virus transmission among individuals who use and inject drugs, it also elevates the risk of premature mortality. Table Injecting status of new presentations to treatment Injecting Status Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n % n % n % Never injected 17,014 40% 14,715 90% 16,571 91% 50,000 97% 98,300 76% Previously injected 14,614 34% 1,180 7% 1,434 8% 1,472 3% 18,700 14% Currently injecting 11,263 26% 430 3% 205 1% 117 0% 12,015 9% Declined to answer 93 0% 29 0% 53 0% 133 0% 308 0% Total 42, % 16, % 18, % 51, % 129, % Missing/inconsistent ,893 Total 43,142 16,775 18,716 52, ,216 *Percentages may equal 0% or not sum to 100% due to rounding 4.11 Housing situation (new presentations) Table shows the housing status of individuals at the time that they presented to treatment. Of the 129,351 individuals (99%) who provided their housing status, 7% reported an urgent housing problem, usually no fixed abode (NFA), with a further 11% reporting some form of current housing problem (such as staying with friends or family as a short term guest or residing at a short-term hostel). Opiate clients had the highest rates of urgent housing problems (14%) and alcohol only clients the least (3%). Individuals who present to treatment using NPS are much more likely to have an urgent housing problem compared to those not using these substances at the start of treatment (18% vs 7%). Particularly high rates of housing need (48%) were reported by presenting clients citing both opiates and NPS at the start of treatment, compared to 27% for opiate clients overall. 30

31 Table Housing situation of new presentations to treatment Housing situation Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n % n % n % No problem 29,830 70% 13,350 81% 14,292 77% 45,941 89% 103,413 80% Housing problem 6,439 15% 1,694 10% 2,294 12% 4,086 8% 14,513 11% Urgent housing problem (NFA) 6,122 14% 643 4% 1,093 6% 1,584 3% 9,442 7% Other 94 0% 837 5% 820 4% 232 0% 1,983 2% Total 42, % 16, % 18, % 51, % 129, % Inconsistent/missing ,865 Total 43,142 16,775 18,716 52, ,216 *Percentages may equal 0% or not sum to 100% due to rounding 31

32 5. Access to services 5.1 Waiting times for first and subsequent treatment interventions Overall, nearly all individuals (98%) waited three weeks or less from first being identified as having a treatment need to being offered an appointment to start an intervention, with 82% of first interventions having zero days waiting time. There was marginal variation in waiting times between the four substance groups. Similarly, for individuals that started a subsequent intervention, the vast majority (96%) did so within three weeks. The average (mean) waiting time for first interventions of all individuals was 2.2 days, this ranged from 1.7 days for opiate clients to 2. 7 days for alcohol only clients. Table Waiting times, first and subsequent interventions Intervention First intervention Subsequent intervention 3 weeks or Over 3 Average 3 weeks or Over 3 under weeks waiting time under weeks n % n % days n % n % Opiate 63,548 99% 751 1% ,960 97% 1,739 3% Non-opiate only 17,217 98% 293 2% 2.3 1,630 97% 57 3% Non-opiate and alcohol 19,399 98% 441 2% 2.7 5,633 92% 483 8% Alcohol only 53,745 98% 1,343 2% ,951 93% 1,138 7% Total 153,909 98% 2,828 2% ,174 96% 3,417 4% 5.2 Treatment interventions As part of a treatment journey, an individual may receive more than one intervention (i.e. more than one type of treatment) while being treated at a provider and may attend more than one provider for subsequent interventions. Before 1 November 2012 there were six structured treatment intervention types. However, from 1 November 2012 the way in which interventions were recorded on NDTMS was changed to only recording three high-level intervention types: psychosocial, pharmacological and recovery support, as well as an intervention setting and a series of sub-interventions that provided more detail on the treatments being delivered. Table shows the number of clients who received each intervention type in their latest treatment journey for individuals receiving interventions that commenced prior to 1 November 2012 or use the pre 2012 dataset change coding. Individuals are only counted once for each intervention type they received. 32

33 Table Interventions received by clients in treatment , pre November 2012 data set change interventions Non-opiate Alcohol Intervention Opiate Non-opiate and alcohol only Total Inpatient detoxification 2, ,381 Structured day programme 5, ,702 Residential rehabilitation Structured intervention 14, ,203 Old YP intervention *Individuals may have more than one type of intervention and so may appear on more than one row Table provides information on interventions commenced after the changes to the core dataset introduced on 1 November 2012 (see section 9.2 for more detail on this change). It shows the number of clients who received interventions starting on or after 1 November 2012 based on the new intervention codes and intervention setting. If an individuals intervention features in table 5.2.2, and can be directly mapped between tables, it is not featured in table above to avoid double counting. 33

34 Table Interventions received by clients in treatment , post November 2012 data set change interventions Substance group Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total Setting Intervention type Psychosocial Prescribing n % n % Total* Community 133,753 95% 128,464 94% 140,973 Inpatient unit 4,688 3% 5,477 4% 5,648 Primary care 15,171 11% 26,444 19% 27,297 Residential 2,481 2% 1,170 1% 2,637 Recovery house 105 0% 182 0% 268 Missing 2,669 2% 7,679 6% 8,691 Other 4 0% 2 0% 4 Total* 140, % 137, % 146,321 Community 23,544 97% 1,513 82% 23,685 Inpatient unit 106 0% 100 5% 110 Primary care 527 2% % 648 Residential 208 1% 27 1% 208 Recovery house 28 0% 2 0% 28 Missing 6 0% 13 1% 14 Other 36 0% 1 0% 36 Total* 24, % 1, % 24,366 Community 27,093 97% 2,908 65% 27,204 Inpatient unit 1,223 4% 1,435 32% 1,450 Primary care 381 1% 189 4% 471 Residential 1,263 5% 417 9% 1,328 Recovery house 40 0% 7 0% 47 Missing 7 0% 4 0% 11 Other 26 0% 3 0% 28 Total* 27, % 4, % 27,973 Community 76,381 97% 12,170 72% 77,055 Inpatient unit 3,914 5% 4,558 27% 4,650 Primary care 1,700 2% 701 4% 2,010 Residential 2,093 3% 922 5% 2,298 Recovery house 71 0% 25 0% 95 Missing 3 0% 1 0% 4 Other 10 0% - 0% 10 Total* 79, % 17, % 79,829 Community 260,771 96% 145,055 90% 268,917 Inpatient unit 9,931 4% 11,570 7% 11,858 Primary care 17,779 7% 27,589 17% 30,426 Residential 6,045 2% 2,536 2% 6,471 Recovery house 244 0% 216 0% 438 Missing 2,685 1% 7,697 5% 8,720 Other 76 0% 6 0% 78 Total* 272, % 160, % 278,489 34

35 *This is the total number of individuals receiving each intervention type and not a summation of the psychosocial and prescribing columns. **Percentages may equal 0% or not sum to 100% due to rounding Data from tables and can be summed where overlap in definition exists to arrive at the total number of individuals receiving each intervention in No overlap exists for structured day programmes or other structured interventions thus the total number of clients can only be reported up to the 31 October A count of the total number of individuals by setting/intervention where it is possible to sum the overlap between tables and 5.2.2, can be found in table below. Table Total number of individuals in settings (overlap between and 5.2.2) Setting Total number of individuals Inpatient unit 14,239 Residential 7,080 Table below provides a breakdown of clients receiving a prescribing intervention, by the length of time that they had been in receipt of it; either when they exited treatment, or, if still in treatment, the length of time they have been receiving a prescribing intervention. Just under half of individuals (44%) had been in receipt of prescriptions for less than 12 months, with variation between substance groups (36% for opiate clients to 94% for alcohol only clients). Over a fifth of opiate clients (22%) received prescribing treatment for over five years compared to less than 1% for those receiving interventions for alcohol only. The majority of individuals either received prescriptions as part of opiate substitution therapy or to enable safe withdrawal from alcohol dependence. Perscriptions to help with relapse prevention make up the majority of those remaining. Table Length of time in prescribing for clients in continuous prescribing treatment Length of time Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n % n % n % Less than 12 months 50,126 36% 1,326 72% 4,067 91% 15,904 94% 71,423 44% 1-2 years 24,252 18% % 248 6% 837 5% 25,591 16% 2-3 years 16,757 12% 92 5% 49 1% 162 1% 17,060 11% 3-4 years 9,176 7% 52 3% 36 1% 60 0% 9,324 6% 4-5 years 6,676 5% 16 1% 20 0% 26 0% 6,738 4% 5 years + 30,345 22% 100 5% 29 1% 20 0% 30,494 19% Total 137, % 1, % 4, % 17, % 160, % *Percentages may equal 0% or not sum to 100% due to rounding 35

36 5.3 Engagement Of the 279,793 individuals in contact with treatment services during , 92% (257,552) were either retained for more than 12 weeks, or if leaving treatment before completing 12 weeks, did so free of dependence. Opiate clients were most likely to be retained in treatment for over 12 weeks or complete treatment successfully before this time (95%) compared to nonopiate only (87%), non-opiate and alcohol (88%) and alcohol only clients (90%). Table Clients retained to treatment for more than 12 weeks or successfully completing treatment in Substance Number in contact with treatment services Number retained in treatment for more than 12 weeks or successfully completing treatment in n n % Opiate 146, ,899 95% Non-opiate only 24,561 21,282 87% Non-opiate and alcohol 28,242 24,748 88% Alcohol only 80,454 72,623 90% Total 279, ,552 92% 36

37 6. Treatment and recovery outcomes 6.1 Treatment exits and successful completions Table shows the reasons for clients exiting treatment in There were 127,475 individuals who left treatment after the 31 March 2016 and before the 1 April Of these, 62,500 (49%) were discharged as treatment completed. This is determined by clinical judgement that the individual no longer has a need for structured treatment, having achieved all the care plan goals and having overcome dependent use of the substances that brought them into treatment. Figure represents the percentage of successful completions among the four substance groups. Opiate clients have the lowest rate of successful completions (26%), compared to the other three substance groups (ranging from 54% for non-opiate and alcohol clients to 61% for alcohol only clients). Of the discharged opiate clients, 14% were transferred for further treatment within the community, but were not picked up in treatment within 21 days, and 12% were transferred for further treatment in custody. The other 48% of opiate clients that left without completing treatment were discharged largely as either having dropped out or left treatment (39%). In comparison, around 40% of clients in the other substance groups exited having not completed treatment successfully, with unsuccessful transfers within the community accounting for between 3 to 5% of exits. Alcohol only clients had the lowest proportion of clients dropping out of treatment (29%). On average (mean), individuals who completed treatment did so after days. However, the average number of treatment days ranged from days for opiate clients to under 220 days for all the other substance groups (170.2 for non-opiate only clients, for non-opiate and alcohol clients and for alcohol only clients). During , 2,680 clients died while in contact with treatment. Most of these were opiate clients (1,741, 65% of all deaths) with a median age of 45 years. This makes up 1.2% of all opiate clients in treatment. A further 767 alcohol only clients (29% of all deaths) died during treatment (1% of all alcohol only clients in treatment). This group had the highest median age of those individuals that died (50 years). In comparison, non-opiate and alcohol (5%) and non-opiate only clients (2%) made up only a small percentage of total number of deaths while in contact with treatment services. Non-opiate and alcohol deaths had a median age of (39 years), whereas non-opiate only clients had the lowest median age, with the majority aged under 40 (34 years). Of all the clients that died while in contact with treatment, 72% were male, ranging from 63% for alcohol only clients and 84% for non-opiate and alcohol clients. For the opiate group 74% of deaths were males. 37

38 Table Treatment exit reasons for clients not retained in treatment on 31 March 2017 Treatment exit reason Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n % n % n % Completed free of dependence no drug or alcohol use 9,116 23% 6,293 37% 5,870 32% 19,375 37% 40,654 32% Completed free of dependence 1,323 3% 3,751 22% 4,165 22% 12,607 24% 21,846 17% Treatment completed free of dependence subtotal 10,439 26% 10,044 59% 10,035 54% 31,982 61% 62,500 49% Dropped out/left 15,394 39% 5,438 32% 6,457 35% 15,091 29% 42,380 33% Transferred not in custody 5,496 14% 553 3% 857 5% 2,384 5% 9,290 7% Transferred in custody 4,660 12% 423 2% 397 2% 430 1% 5,910 5% Treatment declined 529 1% 345 2% 451 2% 1,262 2% 2,587 2% Died 1,741 4% 44 0% 128 1% 767 1% 2,680 2% Prison 829 2% 97 1% 105 1% 143 0% 1,174 1% Treatment withdrawn 245 1% 49 0% 106 1% 182 0% 582 0% Exit reason inconsistent 180 0% 34 0% 44 0% 114 0% 372 0% Total 39, % 17, % 18, % 52, % 127, % *Percentages may equal 0% or not sum to 100% due to rounding Figure Proportion of exits that are treatment completed free of dependence by the four substance groups % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Opiate Non-opiate Non-opiate and alcohol Alcohol only Full definitions of all the treatment exit reasons below can be found in the NDTMS business definitions at: 38

39 6.2 Six-month outcomes Introduction The Treatment Outcomes Profile (TOP) is a clinical tool that enables clinicians and key workers to keep track of the progress of individuals through their treatment journeys. It originally consisted of a 20 item questionnaire focusing on substance use, injecting risk behaviour, housing, employment, crime and health and quality of life. In November 2013, the Alcohol Outcomes Record (AOR) was introduced to NDTMS. The AOR is a four-item condensed version of the TOP, which monitors change in the frequency and quantity of alcohol consumption, as well as physical health and psychological health. Treatment providers can utilise either the TOP or the AOR to monitor alcohol only clients. For all other clients, the TOP is expected to be completed. The data in this section includes an analysis of all TOP/AOR review data received in that complies with the TOP reporting protocols below and for which there is also corresponding treatment start TOP information The AOR is not specifically required to be completed for six-month in-treatment outcomes monitoring, but such instances are included here where the data is available. The reporting protocols stipulate that an individual can have a review completed between 29 and 182 days following their initial assessment. A total of 90,154 individuals had a review TOP/AOR occurring in and also had corresponding TOP data at treatment start, and the outcomes of these individuals are reported here. Methods A statistical approach known as the Reliable Change Index (RCI) is used here to classify the changes in substance use between the start of treatment and six-month review into one of four categories: abstinent, improved, unchanged and deteriorated. This is based on the application of methodology advanced by Jacobson and Truax (1991) 7 and verified for use in the substance misuse field by Marsden et al (2011). 8 Results Table presents the change in substance use between the start of treatment and the sixmonth review. It is segmented by the four substance groups and reports on the substances that were cited as problematic on presentation to treatment. Opiate clients that were not also citing 7 Jacobson N. S., Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 1991; 59: Marsden, J., Eastwood, B., Wright, C., Bradbury, C., Knight, J., Hammond, P. How best to measure change in evaluations of treatment for substance use disorder. Addiction 2011: 106(2): onlinelibrary.wiley.com/doi/ /j x/pdf 39

40 crack cocaine reported the largest reductions in average (mean) number of days of opiate use, 15.4 days (from 22.7 days to 7.3 days), this compared to a reduction of 12 days for those also using crack (from 21.6 days to 9.7 days). Forty-six per cent of opiate clients not citing crack had stopped using illicit opiates by the time of their six-month review, and for individuals also citing crack, 32% achieved abstinence from illicit opiates by six-months. For non-opiate only clients, the largest reduction of average days use was observed for cannabis (10.9 days reduction in non-opiates only and 9.8 days reduction in non-opiates and alcohol clients). Those clients citing cocaine and amphetamines reported the highest rates of abstinence at six months (66% of both non-opiate only clients and of non-opiate and alcohol clients were reported as abstinent for cocaine, and 61% of non-opiate only clients and 68% of non-opiate and alcohol clients were reported as abstinent for amphetamine). For individuals presenting with alcohol only, the average number of drinking days was 21.2 days at the start of treatment and fell to 11.3 days by the time of six-month review, with 33% reporting abstinence. Being abstinent or improved at the six-month review is associated with eventual successful completion from treatment. Individuals treated for powder cocaine and cannabis typically have better outcomes than individuals that use opiates. They are likely to have fewer associated social problems, draw on greater personal resources, and receive more social support. As a result, their prospects of overcoming dependence are usually better than those of opiate clients. Data on tobacco is included for the first time. Figure shows the proportion of clients smoking in the 28 days period prior to the start of treatment, split by drug group and gender. Overall, opiate clients had the highest rates of smoking when commencing treatment (59%), this was followed by non-opiates and alcohol and non-opiates only (52% and 49% respectively). Those presenting with alcohol only had the lowest rates with 34% smoking at the start of treatment. Across the four drug groups, males and females reported smoking at similar levels, and in all cases the level of smoking was substantially higher than the smoking rates of the general population (17% for males and 14% for females). For opiate clients and non-opiate only clients, tobacco was the substance with the lowest proportion reporting cessation by their six-month review (23% and 34%, respectively [Table 6.2.1]). For alcohol only and non-opiate and alcohol clients, the proportion of clients no longer reporting tobacco use is similar to non-opiate only clients. Opiate clients reported the highest number of days using tobacco at both the start of treatment (27.3 days) and at the six-month review (21.3 days). 40

41 Table Change in use of cited substance for clients with a review TOP/AOR in the year who reported using at the start of treatment START OF TREATMENT AT SIX MONTH REVIEW Reviewed Substance clients Average Average using at days of use days of use start at start Abstinent Improved Unchanged Deteriorated at review n mean % % % % mean Opiate Opiate use (all opiate clients) 22, % 26% 31% 4% 8.5 Opiate use (opiate not crack clients) 10, % 24% 27% 3% 7.3 Opiate use (opiate and crack clients) 11, % 27% 35% 5% 9.7 Crack use (in opiate and crack clients) 10, % 17% 37% 7% 7.5 Cocaine use % 4% 20% 2% 1.8 Amphetamine use % 6% 36% 6% 5.7 Cannabis use 3, % 8% 36% 7% 9.6 Alcohol use 4, % 13% 49% 9% 13.1 Tobacco use 11, % Injecting 6, % 13% 30% 3% 7.5 Non-opiate only Crack use % 10% 28% 3% 4.6 Cocaine use 2, % 12% 20% 2% 2.5 Amphetamine use % 7% 30% 2% 5.3 Cannabis use 5, % 18% 42% 2% 11.4 Tobacco use 3, % Injecting % 5% 29% 2% 3.9 Non-opiate and alcohol Crack use % 5% 33% 3% 4.7 Cocaine use 3, % 10% 23% 1% 2.4 Amphetamine use % 4% 26% 2% 4.0 Cannabis use 4, % 11% 36% 4% 9.5 Alcohol use 10, % 18% 47% 3% 9.9 Tobacco use 3, % Injecting % 1% 20% 1% 2.8 Alcohol only Alcohol use 34, % 20% 45% 3% 11.3 Tobacco use 7, %

42 Figure Smoking prevalence at start of treatment by the four substance groups % 60% 50% 40% 30% 20% 10% 0% Male Female Opiate Non-opiate Non-opiate and alcohol Alcohol only General population Table presents the six-month outcomes in employment, education and housing status by the four substance groups. Opiate clients were much less likely to be in paid work or to be in education, and more likely to have issues with housing compared to individuals presenting with other substances. Sixteen per cent of opiate clients reported some paid employment in the 28 days before treatment commenced compared to 30% for non-opiate only clients, 29% for nonopiate and alcohol clients and 28% for alcohol only clients. There was a small increase in the proportion of opiate clients in paid work by the time of the six-month review (16% to 19%), with the average days of paid work decreasing slightly (0.4%) during this time. Non-opiate only clients saw a similar increase in the proportion reporting paid work, (30% to 33%), while non-opiate and alcohol and alcohol only clients demonstrated only marginal change in paid employment. Nineteen per cent of opiate clients reported an acute housing problem at the start of treatment, which fell to 14% by the time of the six-month review. Improvements were also seen in individuals presenting with other substances, ranging from a 4% drop for non-opiate only clients and non-opiate and alcohol clients to 3% for alcohol only clients. 42

43 Table Change in employment, education and housing status between the start of treatment and six-month review Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total Employment n 29,569 10,377 11,486 35,930 87,362 Baseline work Review work % 16% 30% 29% 28% 24% Mean days % 19% 33% 30% 28% 26% Mean days Education n 29,487 10,324 11,403 35,556 86,770 Baseline education % 1% 3% 2% 2% 2% Mean days Review education % 1% 4% 3% 2% 2% Mean days Housing problems acute n 29,500 10,236 11,361 35,477 86,574 Baseline % 19% 10% 12% 7% 12% Review % 14% 6% 8% 4% 8% Housing problems risk n 29,311 10,215 11,298 35,309 86,133 Baseline % 7% 5% 6% 3% 5% Review % 6% 3% 4% 2% 4% Housing problems any n 29,280 10,201 11,284 35,256 86,021 Baseline % 20% 11% 13% 8% 13% Review % 15% 7% 8% 5% 9% 43

44 7. Trends over time 7.1 Trends in numbers in treatment Table and figure show the change in clients in contact with substance misuse treatment between and by the four main substance groups. Overall, 279,793 individuals were in contact with drug and alcohol services in ; this is a 3% reduction from the previous year. The number receiving treatment for alcohol only decreased the most (5%, 85,035 to 80,454) and the number of alcohol only clients in contact with treatment has fallen by 12% from the 91,651 peak in The number of opiate clients in contact with treatment has fallen each year since a peak of 170,032 in down to 146,536 in , a 14% fall. The number of non-opiate only clients in treatment has remained relatively stable over the last 12 years. Table Trends in numbers in treatment Year Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n % n % n ,557 65% 26,287 12% 14,737 7% 35,221 16% 216, ,596 64% 28,777 12% 18,154 8% 40,114 17% 241, ,997 61% 27,398 10% 22,741 9% 54,696 21% 265, ,005 56% 27,186 9% 28,560 9% 78,658 26% 304, ,032 55% 24,557 8% 28,992 9% 88,086 28% 311, ,144 55% 23,613 8% 28,223 9% 88,020 28% 309, ,435 54% 22,982 8% 27,732 9% 86,416 29% 299, ,959 53% 23,975 8% 27,627 9% 87,544 29% 297, ,852 52% 25,570 8% 28,871 10% 91,651 30% 301, ,964 52% 25,025 8% 28,128 10% 89,107 30% 295, ,807 52% 25,814 9% 28,187 10% 85,035 29% 288, ,536 52% 24,561 9% 28,242 10% 80,454 29% 279,793 * Providers of specialist alcohol treatment services began to report to NDTMS in

45 Adult substance misuse statistics from NDTMS Figure Trends in numbers in treatment 180, ,000 Opiate 140, , ,000 Alcohol only 80,000 60,000 40,000 Non- 20,000 - Non-opiate and alcohol Opiate Non-opiate Non-opiate and alcohol Alcohol only 7.2 Trends in age group and presenting substances Figures and (on the following page) show trends in the substances cited as problematic among new presentations from to The data behind these graphs can be found in table in the supporting tables document There were 52,803 non-opiate and non-opiate & alcohol clients in contact with treatment in , which was a 2% fall since last year. Despite this overall fall in numbers in treatment for non-opiate substances, the number of individuals presenting with crack cocaine problems (not being used alongside opiates) increased by 23% (2,980 to 3,657), this follows a smaller increase of 3% in crack cocaine presentations between and It is likely that the recent increase in the number of people entering treatment for crack problems reflects the rise in the prevalence of the use of the drug. Recently published estimates of crack cocaine use in England in reported a 10% increase in the numbers estimated to be using the substance since (166,640, 95% confidence interval 161, ,706 to 182,828, 95% confidence interval 176, ,782). 45

46 Whilst the total number of opiate users has fallen from to , opiates with crack cocaine use has risen from 19,485 to 21,854 overtaking opiates without crack for the first time. Figure shows that the increase in opiate and crack citation is driven by an increase in the over 40s and a smaller increase among 30 year olds. Figure indicates that the increase in crack cocaine problems (not being used alongside opiates) is spread more evenly across age categories than the opiates and crack figure. The under 25s show an increase of 83 clients citing crack without opiates, an increase of 30% from This fall in younger opiate users presenting for treatment mirrors the trends seen in the estimated prevalence of opiate and/or crack cocaine use among individuals aged 15-24, where the estimated (midpoint) number has fallen from 72,838 ( ) to 18,337 ( ). Prevalence estimates can be found at: and methodology can be found at: The number of citations for other substances in this younger age group also fell, reflecting the general reduction in the total number of younger individuals (aged 18-24) presenting for treatment over the last six years (see figure 7.2.4). Large percentage reductions for this group were seen in citations for amphetamine (other than ecstasy) (1,432 in to 496 in , a reduction of 65%) and benzodiazepines (1,104 in to 467 in , a reduction of 58%). Overall, the number of under-25s accessing treatment has fallen by 37% since ; this reflects changes in the patterns of drinking and drug use in this age group over the last 11 years. Alcohol citations have fallen by 45% between 2009/10 and 2015/16 which reflects a general downward trend in young people s drinking, as reported in the Smoking, Drinking and Drug Use Among Young People in England survey for 2014, which reported that 38% of year olds had tried alcohol at least once, the lowest proportion since the survey began. The trends in new treatment presentations for other drugs vary since Cannabis peaked in but has fallen by 13% over the last three years (30,422 to 26,615). Cocaine has seen a 20% increase since (14,115 to 16,892). Since alcohol service providers started reporting to NDTMS, alcohol citations have fallen from a peak of 94,152 in 2014/15 to 79,202 in 2016/17. Trends in age and presenting substances among all clients in treatment can be found in the supporting tables 46

47 Adult substance misuse statistics from NDTMS Figure Number of new treatment presentations for opiates and / or crack cocaine 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 - Opiate (not crack cocaine) Both opiate and crack cocaine Crack cocaine (not opiate) Opiate (not crack cocaine) Both opiate and crack cocaine Figure Number of new treatment presentations for other substances 100,000 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 - Cannabis Amphetamine (other than ecstasy) Benzodiazepine Cocaine Alcohol Cannabis Cocaine Benzodiazepine Amphetamine (other than ecstasy) Alcohol Pre alcohol data is not included in figure as alcohol providers data was only fully collected from onwards 47

48 Adult substance misuse statistics from NDTMS Figure Presenting substance of under 25s for opiate and/or crack Opiate (not crack cocaine) Both opiate and crack cocaine Crack cocaine (not opiate) Opiate (not crack cocaine) Both opiate and crack cocaine Crack cocaine (not opiate) Figure Presenting substances of under 25s for other substances Alcohol 8000 Cannabis Cocaine Amphetamine (other than ecstasy) 0 Benzodiazepine Cannabis Cocaine Benzodiazepine Amphetamine (other than ecstasy) Alcohol Pre alcohol data is not included in figure as alcohol providers data was only fully collected from onwards 48

49 Figure Number and age of new treatment presentations for opiates and crack cocaine Figure Number and age of new treatment presentations for crack cocaine without opiate

50 Table New treatment presentations by year for clients under Opiate and/or crack cocaine use Opiate (not crack cocaine) 7,487 5,884 4,899 4,456 4,279 3,347 2,633 2,164 1,951 1,718 1,403 1,104 35% 30% 23% 20% 20% 17% 15% 13% 12% 12% 11% 9% Both opiate and crack cocaine 3,864 3,485 3,707 3,353 2,581 2,294 1,742 1,473 1,272 1, % 18% 18% 15% 12% 12% 10% 9% 8% 7% 7% 8% Crack cocaine (not opiate) 1,074 1,126 1,193 1, % 6% 6% 5% 4% 3% 3% 2% 2% 2% 2% 3% Other drug use Cannabis 7,290 7,147 7,895 8,781 8,987 8,672 8,620 8,399 8,188 7,369 7,095 6,322 34% 36% 37% 40% 43% 44% 48% 51% 51% 52% 54% 54% Cocaine 3,508 4,124 4,955 5,464 4,420 4,006 3,847 3,659 3,541 3,272 3,137 3,113 16% 21% 23% 25% 21% 21% 22% 22% 22% 23% 24% 27% Benzodiazepine 1, ,081 1, Amphetamine (other than ecstasy) 5% 5% 5% 5% 5% 5% 5% 4% 3% 4% 4% 4% 1,432 1,483 1,582 1,367 1,288 1,741 1,602 1,642 1,420 1, % 8% 7% 6% 6% 9% 9% 10% 9% 9% 7% 4% Other 1,786 1,810 1,955 1,766 1,870 1,637 1,490 1,621 1,758 1,702 1,971 1,391 8% 9% 9% 8% 9% 8% 8% 10% 11% 12% 15% 12% Alcohol Alcohol 5,561 5,730 7,628 9,673 9,574 9,138 8,569 7,560 7,284 6,290 5,779 5,221 26% 29% 36% 44% 45% 47% 48% 45% 45% 44% 44% 45% Total number of individuals* 21,283 19,708 21,140 22,129 21,080 19,495 17,845 16,622 16,085 14,178 13,231 11,657 50

51 Adult substance misuse statistics from NDTMS 7.3 Trends in club drug and new psychoactive substance (NPS) use Table and figure report the number of individuals aged 18 or over presenting to treatment in the years to , where the individual reported using an NPS or one or more club drug(s). Club drugs and NPS bring together a number of different substances typically used in bars and nightclubs, concerts and parties, before and after a night out. The number of citations of NPS or club drugs by individuals presenting to treatment increased from 2,243 in to 6,322 in before falling to 4,315 in This represents a 32% decrease driven by a large fall in NPS and Mephedrone and a decrease in Ecstasy citations. Citations of NPS fell from 2,042 in to 1,450 in , a 29% reduction. Figure shows this reduction separated by age group. Whilst there is a reduction for all age groups the overall fall is driven largely by the under 25s where there has been a fall from 627 in to 321 in (51% reduction). Mephedrone citations fell from 1,647 in to 502 in , a 70% reduction. This follows a 19% reduction in Figure displays this reduction split by age groups. It displays significant reductions in all age groups with the greatest falls among the youngest groups, 80% fall for under 25s and 76% for Ketamine citations have risen by 136 in , a 25% increase. This rise is similar to but follows a significant fall between and Methamphetamine citations have risen by 28, this represents a rise of 9% and follows a similar trend since Ecstasy citations have decreased by 305 since (23%). Figure Trends in number of new presentations to treatment citing club drug use 3,000 2,500 2,000 Ecstasy Mephedrone New psychoactive substances 1,500 1,000 Ketamine GHB/GBL Methamphetamine Ecstasy Ketamine GHB/GBL Methamphetamine Mephedrone New psychoactive substances The data used in figure is contained in the supporting tables 51

52 Table Trends in number of new presentations citing club drugs or new psychoactive substances Club drug and new psychoactive substances Ecstasy 2,086 1,756 1,284 1,267 1,329 1,214 1,284 1,318 1,013 Ketamine , GHB/GBL Methamphetamine Mephedrone* ,044 1,836 1,895 2,024 1, New psychoactive substances** ,154 2,042 1,450 Further breakdown of new psychoactive substances: Predominantly stimulant Other Predominantly cannabinoid , Predominantly hallucinogenic Predominantly sedative/opioid Predominantly dissociative Total number of citations*** 2,243 2,727 3,396 3,487 4,603 4,991 5,574 6,322 4,315 Total number of individuals**** 2,205 2,650 3,112 3,164 4,081 4,431 4,853 5,537 3,818 Total number in treatment 110, , , , , , , , ,216 Data for years to is contained in the supporting tables *A code for mephedrone was added to the NDTMS core dataset in Any clients reporting mephedrone prior to this are included in the total but no separate total is given for mephedrone. **Codes for NPS were added to NDTMS core dataset in Any clients reporting NPS prior to this are included in the total but no separate figure is given for NPS. *** This total is for the substances listed in the top part of the table (excluding NPS) plus the individual citations of the NPS substances in the bottom half of the table as clients may have multiple citations for different NPS substances. **** This is a count of individuals as clients may cite multiple NPS substances in the same treatment journey. 52

53 Figure Number and age of new treatment presentations for NPS Figure Number and age of new treatment presentations for mephedrone Trends in treatment exit reasons Table reports treatment completed free of dependence for individuals in the years to broken down by the four main substance groups. Overall, the proportion of individuals completing treatment free of dependence, out of those leaving treatment in the year, increased between and from 24% to 53%. Since then the rate had remained stable, until falling to 50% in and 49% in 2016/17. Opiate clients completing free of dependence reached a peak in , but since then there has been a decrease from 37% to 26% of clients completing treatment free of dependence. In comparison, the proportion of alcohol only clients in treatment exiting free of dependence has gradually increased from just under half (49%) in to 61% in

54 Trends in all treatment exit reasons can be found in the supporting tables Table Trends in treatment completed free of dependence Year Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n % n % n % ,395 18% 3,311 25% 2,044 28% 6,326 34% 18,076 24% ,500 21% 4,278 32% 2,755 34% 7,201 38% 21,734 29% ,448 25% 5,766 40% 4,470 41% 11,252 45% 30,936 35% ,621 33% 7,745 51% 7,654 51% 21,115 51% 49,135 45% ,832 27% 8,023 55% 8,414 51% 24,862 49% 52,131 43% ,636 33% 9,144 60% 9,418 56% 29,566 56% 61,764 49% ,792 37% 9,568 64% 10,060 59% 31,102 59% 65,522 53% ,834 36% 9,917 64% 10,186 60% 33,839 60% 67,776 53% ,882 33% 10,939 63% 10,578 58% 36,164 61% 70,563 53% ,685 30% 10,568 64% 10,376 58% 35,159 61% 67,788 52% ,463 28% 10,545 60% 9,955 56% 33,203 62% 64,166 50% ,439 26% 10,044 59% 10,035 54% 31,982 61% 62,500 49% 7.5 Trends in waiting times for first intervention Table presents trends in the number and proportion of individuals that waited three weeks and under to commence their treatment following the date of referral. Overall, the proportion waiting three weeks or less has increased from 84% in to 98% in The largest improvements in waiting times have been seen in individuals presenting with problematic alcohol use, either alone or in conjunction with non-opiates. Table Trends in waiting times of three weeks and under for first intervention Year Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total n % n % n % n % n % ,058 87% 5,309 88% 3,300 84% 6,937 73% 40,604 84% ,619 87% 12,141 88% 8,089 83% 14,761 74% 84,610 84% ,438 91% 14,788 91% 11,964 86% 25,076 77% 107,266 87% ,683 93% 15,016 93% 15,828 87% 38,400 77% 128,927 87% ,911 94% 15,062 95% 15,832 88% 42,483 78% 131,288 88% ,848 96% 14,952 96% 16,219 90% 46,954 82% 131,973 90% ,018 97% 15,800 97% 17,545 92% 48,978 85% 133,341 92% ,812 98% 17,032 97% 18,079 94% 54,550 89% 144,473 94% ,994 98% 18,279 98% 19,625 96% 62,140 93% 164,038 96% ,152 98% 17,599 98% 18,648 96% 60,593 95% 160,992 97% ,784 98% 18,328 98% 19,067 97% 57,886 96% 158,065 97% ,548 99% 17,217 98% 19,399 98% 53,745 98% 153,909 98% 54

55 8. A 12-year treatment population analysis This section presents an analysis of treatment histories for individuals across 12 years of treatment data starting from (the earliest point NDTMS data is considered to be sufficiently robust for comparison with subsequent years). See Quality and methodology Information for information on the methodological implications of this analysis compared with analysis elsewhere in the report where each year s figures are independently calculated. Appendix B reports all individuals that have been in contact with substance misuse treatment on or after 1 April The table is in three sections: the first section reports the number of individuals that start treatment in any given year after 1 April 2005 and who are in treatment on 31 March 2017 the second section reports all individuals who were in contact with treatment in any given year after 1 April 2005 and reports the number of these from each year who were not in treatment after the 31 March 2017, and whose records indicated that treatment was incomplete at the time of discharge (treatment incomplete) the third section looks at all individuals who were in contact with the treatment system on or after 1 April 2005, and who are no longer in contact with the treatment system due to completing their treatment and being discharged in a planned way (treatment complete), and not having returned for treatment during this time Over the 12 years, 875,803 unique individuals have contact recorded with substance use services of whom 145,330, (17%) were still in treatment after the 31 March Thirty-nine per cent (342,309) had exited (treatment incomplete) while a further 388,164, (44%) had completed treatment and not since returned. Figure Last status of all clients in treatment since % 17% 39% Retained at 31st March 2017 Subtotal exited (treatment incomplete) Subtotal treatment complete 55

56 Of the 145,330 individuals who were retained in treatment on the 31 March 2017, a third (29%) were in treatment continuously since their initial commencement. Just under a quarter (21%) were on their second treatment journey and 34% had more than three attempts at treatment. Figure Number of previous treatment journeys for those retained in treatment 31 March 2017 Continuous journey 34% 29% Second journey Third journey 16% 21% More than three journeys Table and figure report on all individuals that have commenced treatment for the first time since 1 April Table gives a breakdown of individuals treatment status at 31 March 2017 by drug group and by the year of the initial contact with the treatment system. There were 292,075 opiate users in contact with the treatment system since , with the majority starting treatment for the first time (known as treatment naïve) in or before (56%, 163,776). The number of opiate clients presenting for the first time has decreased year on year with only 6,117 treatment naïve individuals presenting in The trend in individuals presenting for the first time is different for users of other substances, with the general trend across the two non-opiate groups being relatively stable since and an increase in alcohol treatment naïve presentations up until However, this was due in a large part to only partial data collection on alcohol treatment with full coverage implemented during and Since then the number of alcohol only clients has fallen gradually from 35,170 to 22,

57 Figure Number of clients starting treatment for the first time ever by substance group and year of initial contact * 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 - Prior to Opiate clients Non-opiate clients Non-opiate and alcohol clients Alcohol only clients * complete coverage of alcohol treatment in England was not achieved until

58 Table Treatment contact status at 31 March 2017 by main substance groups for clients commencing treatment since Prior to Year of first presentation Total % Substance group Opiate clients Retained at 31 March ,755 18,348 10,964 8,161 6,805 5,093 3,740 2,996 2,782 2,723 2,616 2,752 3, ,539 36% Subtotal exited (treatment 26,489 20,480 14,094 11,087 9,434 7,434 5,462 4,095 3,498 3,386 2,883 2,465 1, ,281 38% incomplete) Subtotal treatment complete 17,740 11,555 8,351 7,295 6,471 5,120 4,187 3,188 2,535 2,338 1,974 1, ,255 25% Total clients in treatment 79,984 50,383 33,409 26,543 22,710 17,647 13,389 10,279 8,815 8,447 7,473 6,879 6, , % since 1 April 2005 Non-opiate only clients Retained at 31 March ,249 4,665 4% Subtotal exited (treatment 2,426 5,533 4,866 4,603 3,827 3,090 2,630 2,590 2,952 2,963 3,008 3,381 2,172 44,041 41% incomplete) Subtotal treatment complete 1,596 3,037 3,544 4,583 4,698 5,006 5,133 5,466 5,668 6,129 5,704 5,618 3,463 59,645 55% Total clients in treatment 4,101 8,635 8,478 9,244 8,588 8,151 7,829 8,133 8,711 9,222 8,921 9,454 8, , % since 1 April 2005 Non-opiate and alcohol clients Retained at 31 March , ,408 12,343 9% Subtotal exited (treatment 2,511 5,727 5,300 5,989 6,672 5,667 4,788 4,238 4,001 4,071 3,500 3,511 2,314 58,289 40% incomplete) Subtotal treatment complete 2,376 5,257 5,738 7,189 8,280 7,615 6,902 6,565 5,999 5,848 5,227 4,554 2,685 74,235 51% Total clients in treatment since 1 April ,200 11,636 11,662 13,916 15,970 14,143 12,444 11,529 10,725 10,730 9,477 9,028 8, , % 58

59 Prior to Year of first presentation Total % Substance group Alcohol only clients Retained at 31 March , ,063 1,038 1,098 1,327 1,525 2,356 9,590 21,783 7% Subtotal exited (treatment 3,899 8,729 8,415 10,897 15,721 14,299 12,252 10,524 10,130 10,321 9,181 8,278 5, ,698 39% incomplete) Subtotal treatment complete 3,501 7,209 8,458 12,941 18,379 18,217 18,549 17,783 17,718 18,138 16,544 15,246 8, ,029 55% Total clients in treatment 7,594 16,355 17,323 24,539 35,170 33,470 31,864 29,345 28,946 29,786 27,250 25,880 22, , % since 1 April 2005 Total clients Retained at 31 March ,341 19,482 12,106 9,658 8,956 6,963 5,623 4,837 4,696 4,991 5,100 6,526 20, ,330 17% Subtotal exited (treatment 35,325 40,469 32,675 32,576 35,654 30,490 25,132 21,447 20,581 20,741 18,572 17,635 11, ,309 39% incomplete) Subtotal treatment complete 25,213 27,058 26,091 32,008 37,828 35,958 34,771 33,002 31,920 32,453 29,449 27,080 15, ,164 44% Total clients in treatment since 1 April ,879 87,009 70,872 74,242 82,438 73,411 65,526 59,286 57,197 58,185 53,121 51,241 46, , % 59

60 Figure Treatment contact status for the four main substance groups in % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Opiate Non-opiate only Non-opiate and alcohol Alcohol only Total clients Retained at 31st March 2016 Exited (treatment incomplete) Treatment complete Figure presents the status of clients that have been in contact with treatment since by the four substance groups. A quarter (25%) of all opiate clients in treatment since had completed treatment and not returned by 31 March The rate of completion and non-representation for the other substance groups ranged from 51% (non-opiate and alcohol clients) to 55% (non-opiate only clients and alcohol only clients). 60

61 9. History This report presents information relating to drug and alcohol treatment in England. The statistics are derived from data that has been collected through NDTMS. NDTMS collects activity data from drug and alcohol treatment services so that: the progress of individuals entering treatment may be monitored and their outcomes and recovery assessed trends and shifts in patterns of drug use and addiction can be monitored, to inform future planning locally and nationally service users journeys from addiction to recovery can be tracked the impact of drug treatment as a component of the wider public health service may be measured they can demonstrate their accountability to their service users, local commissioners and communities costs can be benchmarked against data from comparable areas to show how efficiently they use resources and how they are delivering value for money Drug treatment activity has been collected nationally for nearly 25 years and has been routinely collected through NDTMS since April NDTMS is currently managed by PHE. NDTMS has been reorganised over the years, bringing the definition of alcohol and drug treatment recorded by the system further into line with Drug misuse and dependence: UK guidelines on clinical management : and Models of care for alcohol misusers : d_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_ pdf Since data has been consistently collected by treatment services, submitting a core data set of their clients information as a database extract. The dataset and data collection methods have also changed. Code sets for the core data set can be found in NDTMS reference data document ( Periodic consulations are undertaken to revise the NDTMS dataset. The most recent revision affecting the statistics in this document is the introduction of core dataset M for the April 2016 data submission. Information regarding future core dataset consultations will be made availiable here: NDTMS figures for England are collated by The National Drug Evidence Centre (NDEC), along with those for Scotland, Wales and Northern Ireland, and combined into a UK return for use by the European Monitoring Centre for Drugs and Drug Addiction (and for the United Nations). 61

62 This statistical release covers England only. Information on drug and alcohol treatment in Wales, Scotland and Northern Ireland is also available: (Wales) (Scotland) (Northern Ireland) While comparisons to drug and alcohol treatment statistics from other countries can be made, care needs to be taken when doing so, as the data is unlikely to be directly comparable due to differences in the definitions and methodologies that are used in collecting the data and in subsequently reporting it. 9.1 Relevant web links and contact details Monthly web-based NDTMS analyses Public Health Outcomes Framework indicators 2.15i, 2.15ii, 2.15iii and 2.15iv National Drug Evidence Centre (NDEC) Public Health England General enquiries For media enquiries, please call or For technical enquiries, please Policy Evidence application team, PHE Data and Statistics Jonathan Knight head of evidence application team, PHE Peter Willey senior information analyst, PHE Andrew Jones research fellow, National Drug Evidence Centre 62

63 9.2 Comparability of data to previous reports In a consultation was undertaken on combining alcohol and drug treatment journeys. Prior to this, when an adult presented to treatment with a primary alcohol treatment episode concurrent with, or followed by, a primary drug treatment episode, this was reported as two separate treatment journeys. A combined treatment journey methodology removes this anomaly and was supported by a majority of respondents to the consultation. This method of client classification was first reported in and data was provided back to Data is now provided back to and is reported in section 7 of this report and the supporting tables As a result of the new reporting framework, comparisons of data in this report with previous adult drug and alcohol statistics prior to are not valid. Interested parties are referred to trend tables 7.1 to 7.5, appendix B and the accompanying more detailed spreadsheets published alongside this report ( where data is reported back to A more detailed explanation of this methodological change can be found in section 2 of this report. The consultation summary can be found at: More information on the consultation can be found at: Since 1 November 2012, PHE made substantial changes to the core dataset with regards to the coding of intervention type. Prior to this, intervention codes were restricted to six broad categories: inpatient, residential rehabilitation, prescribing, psychosocial, structured day programme and other structured treatment. These categories did not easily allow a distinction to be made between the setting where the interventions were delivered and the interventions themselves. Following consultations with clinicians, treatment providers and other key stakeholders, a new method of recording intervention types and settings separately was introduced, alongside the ability for providers to record the non-structured recovery support interventions that they were delivering. As part of the changes in the coding of intervention type, from 1 November 2012 all registered treatment providers are registered with a setting type. There are six adult settings: community, inpatient, residential, recovery house, prison and primary care, which have been incorporated to PHE s regular reporting. Clients in a prison setting are not reported on in this document. Definitions of these settings can be found in section 10.2 and the implementation guide can be found at Intervention types have been split in to three high-level categories; pharmacological interventions, psychosocial 63

64 interventions and recovery support interventions. Recovery support interventions are not reported on in the present report. Due to these implemented changes, most reporting of interventions is limited to those occurring on or after 31 October Therefore, the validity of comparing data to previous years, particularly in tables 5.2.1, and 5.2.3, is limited. 9.3 Drug and alcohol treatment collection and reporting timeline 1989-March 2001 Regional Drug Misuse Database (RDMD) statistics reported in six monthly bulletins by the Department of Health from 1993 to 2001 webarchive.nationalarchives.gov.uk/ / statistics/statistics/statisticalworkareas/statisticalpublichealth/dh_ April 2001-March 2004 National Drug Treatment Monitoring System (NDTMS) statistics reported annually by the Department of Health. April 2004-March 2013 National Drug Treatment Monitoring System (NDTMS) managed by the National Treatment Agency (NTA) reporting statistics annually up to March April 2013 to date National Drug Treatment Monitoring System (NDTMS) managed by Public Health England (PHE) reporting statistics annually from April Other sources of statistics about drugs Prevalence of drug use An annual estimate of the prevalence of drug use is undertaken through the Crime Survey for England and Wales (CSEW, formerly the British Crime Survey (BCS)). This section of the survey has been in place since 1996, annually since 2001, and has tracked the prevalence of the use of different drugs over this time ( A second method is used to produce estimates for the prevalence of crack cocaine and heroin use for each local authority area in England. Estimates are available for , , , , and ( The estimates are produced through a mixture of capture-recapture and Multiple Indicator Methodology (MIM), and rely on NDTMS data being matched against and/or analysed alongside Probation and Home Office data sets. The data and further information are available at: Young people Information is also available relating to the prevalence of drug use among secondary school pupils aged 11 to 15 from the Smoking, Drinking and Drug Use Survey among young people in 64

65 England. This is a survey carried out for the NHS Information Centre by the National Centre for Social Research and the National Foundation for Educational Research. The survey interviews school pupils, and has been in place since It reported annually up to and will now report every two years with the next report due in 2017 reporting for The data and further information are available at: NDTMS collects data on drug and alcohol treatment for young people, and produces official statistics bulletins, which can be found at: It should be noted that young people s treatment figures are not comparable with statistics relating to adult treatment. This is because access to treatment for young people requires a lower severity of drug use and associated problems Criminal justice statistics The Ministry of Justice produces a quarterly statistics bulletin that provides details of individuals in custody and under the supervision of the probation service. These can be found at: The Ministry of Justice also produces statistics relating to aspects of sentencing, including trends in custody, sentences, fines and other disposals. These can be found at: data.gov.uk/dataset/sentencing_statistics_england_and_wales. In addition, NDTMS collects data on drug and alcohol treatment in secure settings and produced the first set of official statistics for on 12 th January The statistics for will be produced in January International comparisons The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) publishes an annual report that describes and compares aspects of drug use and drug policy within European states, as well as providing detailed comparative statistics. This can be found at: The centre also produces a treatment demand indicator (TDI), which is a collection of comparative statistics relating to individuals seeking treatment. This can be found at: 9 Drug Misuse and Dependence - UK Guidelines on Clinical Management, p85, London: Department of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive. 65

66 While comparisons to alcohol treatment statistics from other countries can be made, care needs to be taken as the data is unlikely to be directly comparable due to differences in the definitions and methodologies that are used in collecting the data and subsequently in reporting it Drug-related deaths The Office for National Statistics publishes an annual summary of all deaths related to drug poisoning (involving both legal and illegal drugs) and drug misuse (involving illegal drugs) in England and Wales. tins/deathsrelatedtodrugpoisoninginenglandandwales/2016registrations. 66

67 10. Abbreviations and definitions 10.1 Abbreviations AOR Alcohol Outcomes Record CJS Criminal justice system CSEW Crime survey for England and Wales DIP Drug Intervention Programme DRD Drug-related death EMCDDA European Monitoring Centre for Drugs and Drug Addiction GP General practitioner IBA Identification and brief advice LAPE Local Alcohol Profiles for England LGA Local Government Association ONS Office for National Statistics NDEC National Drug Evidence Centre (University of Manchester) NDTMS National Drug Treatment Monitoring System NHS National Health Service NPS New psychoactive substance NTA National Treatment Agency for Substance Misuse (now part of PHE) PHE Public Health England RDMD Regional drug misuse database ( ) TDI Treatment Demand Indicator TOP Treatment Outcomes Profile YP Young people 67

68 10.2 Definitions Agency/provider Agency/provider code Adjunctive drug use Attributor Client Club drug Community setting Discharge date Drug-related death / drug misuse death A provider of services for the treatment of drug and/or alcohol misuse. It may be statutory (ie, NHS) or non-statutory (ie, third sector, charitable). A unique identifier for the treatment provider (agency) assigned by the regional NDTMS centres eg, L0001. Substances additional to the primary drug used by the client. NDTMS collects secondary and tertiary substances. A concatenation of a client s initials, date of birth and gender. This is used to isolate records that relate to individual clients. A drug user presenting for treatment at a structured treatment service. Records relating to individual clients are isolated and linked based on the attributor and drug partnership of residence. A collective term for a number of different substances typically used by people in bars and nightclubs, at concerts and parties, before and after a night out. A structured drug and alcohol treatment setting where residence is not a condition of engagement with the service. This will include treatment within community drug and alcohol teams and day programmes (including rehabilitation programmes where residence in a specified location is not a condition of entry). Usually the planned discharge date in a client s treatment plan, where one has been agreed. However, if a client's discharge was unplanned, then the date of last face-to-face contact with the provider (agency) is used. Annual figures published by the Office for National Statistics (ONS) since 1993 cover deaths in England and Wales related to drug poisoning (involving both legal and illegal drugs) and to drug misuse (involving illegal drugs). ONS s definition of a drug misuse death is (a) deaths where the underlying cause is drug abuse or drug dependence and (b) deaths where the underlying cause is drug poisoning and where any of the substances controlled under the Misuse of Drugs Act 1971 are involved. 68

69 Where people do suffer drug poisonings while in treatment, these are overwhelmingly classed as drug misuse, so this definition may be seen as more relevant to this population. However, many of those who die in treatment are not included under either definition as they die from causes other than poisoning. Episode Episode of treatment In contact Inpatient setting Intervention First/subsequent intervention A period of contact with a treatment provider (agency): from referral to discharge. A set of interventions with a specific care plan. A client may attend one or more interventions (or types) of treatment during the same episode of treatment. A client may also have more than one episode in a year. A client is considered to have been in contact during the year, and hence included in these results, if any part of an episode occurs within the year. Where several episodes were collected for an individual, attributes such as ethnicity, primary substance, etc, are based on the first valid data available for that individual. Clients are counted as being in contact with treatment services if their date of presentation (as indicated by triage), intervention start, intervention end or discharge indicates that they have been in contact with a provider during the year. An inpatient unit provides assessment, stabilisation and/or assisted withdrawal with 24-hour cover from a multidisciplinary clinical team who have had specialist training in managing addictive behaviours. In addition, the clinical lead in such a service comes from a consultant in addiction psychiatry or another substance misuse medical specialist. The multidisciplinary team may include psychologists, nurses, occupational therapists, pharmacists and social workers. Inpatient units are for those alcohol or drug users whose needs require supervision in a controlled medical environment. A type of treatment, eg, structured counselling, community prescribing, etc. 'First intervention' refers to the first intervention that occurs in a treatment journey. 'Subsequent intervention' refers to interventions within a treatment journey that occur after the first intervention. 69

70 New psychoactive substance (NPS) Non-opiate Opiate Presenting for treatment Primary drug Recovery house setting Referral date Referral source Chemical substances that produce similar effects to established drugs (like cocaine, cannabis and ecstasy). Originally created to side-step legislation, an increasing number are controlled under the Misuse of Drugs Act but all remaining are now covered by the Psychoactive Substances Act Any drug other than those that act on opioid receptors (heroin, methadone, buprenorphine and others) A group of drugs including heroin, methadone and buprenorphine that act on opioid receptors. The first face-to-face contact between a client and a treatment provider. The substance that brought the client into treatment at the point of triage/initial assessment. A recovery house is a residential living environment, in which integrated peer-support and/or integrated recovery support interventions are provided for residents who were previously, or are currently, engaged in treatment to overcome their drug and alcohol dependence. The residences can also be referred to as dry-houses, third-stage accommodation or quasi-residential. The date the client was referred to the provider for this episode of treatment. The source or method by which a client was referred for this treatment episode. Residential rehab setting A structured drug and alcohol treatment setting where residence is a condition of receiving the interventions. Although such programmes are usually abstinence based, prescribing for relapse prevention prescribing or for medication assisted recovery are also options. The programmes are often, although not exclusively, aimed at people who have had difficulty in overcoming their dependence in a community setting. Structured drug treatment Structured drug treatment follows assessment and is delivered according to a care plan, with clear goals, which are regularly reviewed with the client. It may comprise a number of concurrent or sequential treatment interventions. 70

71 Successful completion Treatment journey Triage Triage date Waiting times A term that describes a client that completes treatment successfully as either: treatment completed drug free no longer requiring any structured drug treatment interventions and judged by the clinician not to be using heroin (or any other opioids) or crack cocaine or any other illicit drug or treatment completed occasional user (not heroin and crack) the client no longer requires structured drug treatment interventions and is judged by the clinician not to be using heroin (or any other opioids) or crack cocaine. There is evidence of use of other illicit drug use but this is not judged to be problematic or to require treatment. A set of concurrent or serial treatment episodes linked together to describe a period of treatment based on the clients attributors and DAAT of residence. This can be within one provider or across a number of different providers. An initial clinical risk assessment performed by a treatment provider. A triage includes a brief assessment of the problem as well as an assessment of the client s readiness to engage with treatment, in order to inform a care plan. The date that the client made a first face-to-face presentation to a treatment provider. This could be the date of triage/initial assessment though this may not always be the case. The period from the date a person is referred for a specific treatment intervention and the date of the first appointment offered. Referral for a specific treatment intervention typically occurs within the treatment provider at, or following, assessment. Note: full operational definitions can be found in the NDTMS core data set documents: 71

72 Appendix A Diagram to show flow through treatment This diagram illustrates a typical user journey through the treatment system. It is provided to give an indication of a possible treatment pathway and the interventions received. All pathways will vary depending on the substances used and the clinical requirements of the client, their general health needs and any other relevant issues they may have that will impact on the clinical care provided. 72

Adult Drug Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2013 to 31 March 2014

Adult Drug Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2013 to 31 March 2014 Adult Drug Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2013 to 31 March 2014 1 About Public Health England Public Health England exists to protect and improve the nation

More information

Secure setting statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016

Secure setting statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016 Secure setting statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016 About Public Health England Public Health England exists to protect and improve the nation

More information

Young People s Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2016 to 31 March 2017

Young People s Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2016 to 31 March 2017 Young People s Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2016 to 31 March 2017 About Public Health England Public Health England exists to protect and improve the nation

More information

Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April March 2012

Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April March 2012 Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2011 31 March 2012 4th October 2012 Vol. 1: The Numbers Executive Summary Of the 197,110 clients aged 18 and over in treatment

More information

Young people s statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2013 to 31 March 2014

Young people s statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2013 to 31 March 2014 Young people s statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2013 to 31 March 2014 1 About Public Health England Public Health England exists to protect and improve the

More information

Substance misuse among young people The data for

Substance misuse among young people The data for Substance misuse among young people The data for 28-9 EFFECTIVE TREATMENT CHANGING LIVES www.nta.nhs.uk Substance misuse among young people The data for 28-9 More teenagers are receiving help for drug

More information

Statistics on Drug Misuse: England, 2008

Statistics on Drug Misuse: England, 2008 Statistics on Drug Misuse: England, 2008 Summary This annual statistical report presents information on drug misuse among both adults and children. It includes a focus on young adults. The topics covered

More information

Statistics on Drug Misuse: England, 2007

Statistics on Drug Misuse: England, 2007 Statistics on Drug Misuse: England, 2007 Summary For the first time, this annual statistical bulletin presents information on drug misuse among both adults and children. The topics covered include: Prevalence

More information

Let s Talk About Weight: A step-by-step guide to brief interventions with adults for health and care professionals

Let s Talk About Weight: A step-by-step guide to brief interventions with adults for health and care professionals : A step-by-step guide to brief interventions with adults for health and care professionals About Public Health England Public Health England exists to protect and improve the nation s health and wellbeing,

More information

National Cancer Intelligence Network Routes to Diagnosis:Investigation of melanoma unknowns

National Cancer Intelligence Network Routes to Diagnosis:Investigation of melanoma unknowns National Cancer Intelligence Network Routes to Diagnosis:Investigation of melanoma unknowns Routes to Diagnosis: Investigation of melanoma unknowns About Public Health England Public Health England exists

More information

Substance Misuse - Improving Services and Supporting Offenders. Nino Maddalena CJ lead Alcohol & Drugs, Public Health England

Substance Misuse - Improving Services and Supporting Offenders. Nino Maddalena CJ lead Alcohol & Drugs, Public Health England Substance Misuse - Improving Services and Supporting Offenders Nino Maddalena CJ lead Alcohol & Drugs, Public Health England Overview Recovery agenda looking at the drug and alcohol problems of the offender

More information

National Cancer Intelligence Network Trends in incidence and outcome for haematological cancers in England:

National Cancer Intelligence Network Trends in incidence and outcome for haematological cancers in England: National Cancer Intelligence Network Trends in incidence and outcome for haematological cancers in England: 2001-2010 Trends in incidence and outcome for haematological cancers in England: 2001-2010 About

More information

BROMLEY JOINT STRATEGIC NEEDS ASSESSMENT Substance misuse is the harmful use of substances (such as drugs and alcohol) for non-medical purposes.

BROMLEY JOINT STRATEGIC NEEDS ASSESSMENT Substance misuse is the harmful use of substances (such as drugs and alcohol) for non-medical purposes. 13. Substance Misuse Introduction Substance misuse is the harmful use of substances (such as drugs and alcohol) for non-medical purposes. The term substance misuse often refers to illegal drugs, but, some

More information

Statistics on Drug Misuse: England, 2009

Statistics on Drug Misuse: England, 2009 Statistics on Drug Misuse: England, 2009 Copyright 2009, The Health and Social Care Information Centre. All Rights Reserved. The NHS Information Centre is England s central, authoritative source of health

More information

UK Complete Cancer Prevalence for 2013 Technical report

UK Complete Cancer Prevalence for 2013 Technical report UK Complete Cancer Prevalence for 213 Technical report National Cancer Registration and Analysis Service and Macmillan Cancer Support in collaboration with the national cancer registries of Northern Ireland,

More information

SMART Wokingham Young persons Screening and Referral Form

SMART Wokingham Young persons Screening and Referral Form SMART Wokingham Young persons Screening and Referral Form Referral Source Date: Name of worker: Contact number: Referring Agency: Email address: Client Information Surname First Name Title Previous Name

More information

National Drug and Alcohol Treatment Waiting Times

National Drug and Alcohol Treatment Waiting Times National Drug and Alcohol Treatment Waiting Times 1 April 30 June 2018 Publication date 25 September 2018 A National Statistics publication for Scotland This is a National Statistics Publication National

More information

Promoting the health and wellbeing of gay, bisexual and other men who have sex with men. Summary Document

Promoting the health and wellbeing of gay, bisexual and other men who have sex with men. Summary Document Promoting the health and wellbeing of gay, bisexual and other men who have sex with men Summary Document 1 Health and wellbeing of men who have sex with men This summary sets out Public Health England

More information

Local action on health inequalities. Introduction to a series of evidence papers

Local action on health inequalities. Introduction to a series of evidence papers Local action on health inequalities Introduction to a series of evidence papers About Public Health England Public Health England exists to protect and improve the nation's health and wellbeing, and reduce

More information

Wandsworth drug and alcohol misuse needs assessment 2014/15

Wandsworth drug and alcohol misuse needs assessment 2014/15 Wandsworth drug and alcohol misuse needs assessment 2014/15 Authors 1) Gosaye Fida, Public Health Lead gfida@wandsworth.gov.uk 2) Theresa McDonald, Drug and Alcohol public health lead nurse tmcdonald@wandsworth.gov.uk

More information

Communicating Newborn Screening Sickle Cell or other haemoglobin variant carrier results

Communicating Newborn Screening Sickle Cell or other haemoglobin variant carrier results South West PHE Screening and Immunisation Team Good Practice Guidance for the communication of newborn screening Sickle Cell or other haemoglobin variant Carrier result Communicating Newborn Screening

More information

Needs Assessment 2011

Needs Assessment 2011 Young People s Substance Misuse Needs Assessment 2011 Part 2: An Overview of Young People in Treatment for Substance Misuse in Somerset May 2012 Produced by the Partnership Intelligence Unit on behalf

More information

Addiction and Substance misuse pathways

Addiction and Substance misuse pathways Addiction and Substance misuse pathways Gordon Morse Chief Medical Officer Turning Point UK Gordon Morse statement of interests Sole employer Turning Point Some unpaid advisory work to the Hepatitis C

More information

NHS Health Check: Diabetes Filter Consultation

NHS Health Check: Diabetes Filter Consultation NHS Health Check: Diabetes Filter Consultation About Public Health England Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities. It does

More information

Statistics on Drug Misuse: England, 2012

Statistics on Drug Misuse: England, 2012 Statistics on Drug Misuse: England, 2012 Copyright 2012, The Health and Social Care Information Centre. All Rights Reserved. Copyright 2012, The Health and Social Care Information Centre. All Rights Reserved.

More information

West Yorkshire Oral Health Needs Assessment 2015 (Draft)

West Yorkshire Oral Health Needs Assessment 2015 (Draft) West Yorkshire Oral Health Needs Assessment 2015 (Draft) This document details the oral health of the people of West Yorkshire and describes the services currently commissioned to meet those needs. It

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Drug Misuse: opiate detoxification of drug misusers in the community, hospital and prison. 1.1 Short title Drug misuse detoxification

More information

Service Specification: Bristol and South Gloucestershire Specialist Substance Misuse Treatment Service January 2016

Service Specification: Bristol and South Gloucestershire Specialist Substance Misuse Treatment Service January 2016 This specification is an annex to the Service Specification for the provision of Child and Adolescent Mental Health Services. It must be read along with the overarching specification which applies to all

More information

Statistics from the Northern Ireland Drug Misuse Database: 1 April March 2012

Statistics from the Northern Ireland Drug Misuse Database: 1 April March 2012 Statistics from the Northern Ireland Drug Misuse Database: 1 April 2011 31 March 2012 This bulletin summarises information on people presenting to services with problem drug misuse and relates to the 12-month

More information

JSNA Substance Misuse

JSNA Substance Misuse JSNA Substance Misuse Introduction 9.1. Substance misuse causes less damage to health in absolute population terms than tobacco or alcohol. However, its association with crime and antisocial behaviour

More information

Harm Reduction Database Wales: Needle and Syringe provision

Harm Reduction Database Wales: Needle and Syringe provision Harm Reduction Database Wales: Needle and Syringe provision 2012-13 Public Health Wales would like to thank all those that contributed to the Harm Reduction Database Wales: NSP service users, NSP staff

More information

Hertfordshire Young People s Substance Misuse Strategic Plan

Hertfordshire Young People s Substance Misuse Strategic Plan Hertfordshire Young People s Substance Misuse Strategic Plan 2014 15 1 1. Introduction and context Young people misusing substances can cause harm to our communities through crime and antisocial behaviour,

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Drug Misuse: opiate detoxification of drug misusers in the community, hospital and prison. 1.1 Short title Drug misuse detoxification

More information

Table 1. Synthetic Estimate for Abstaining from Drinking in Shropshire. Abstaining from Drinking Proportion

Table 1. Synthetic Estimate for Abstaining from Drinking in Shropshire. Abstaining from Drinking Proportion 1 Adult Alcohol Misuse in Shropshire 2013/14 Prevalence of Drinking in Shropshire Who abstains from drinking in Shropshire? Table 1 shows the synthetic estimate of the percentage of the population of Shropshire

More information

Patient survey report Survey of people who use community mental health services 2015 South London and Maudsley NHS Foundation Trust

Patient survey report Survey of people who use community mental health services 2015 South London and Maudsley NHS Foundation Trust Patient survey report 2015 Survey of people who use community mental health services 2015 National NHS patient survey programme Survey of people who use community mental health services 2015 The Care

More information

Dental public health epidemiology programme Oral health survey of five-year-old and 12-year-old children attending special support schools 2014

Dental public health epidemiology programme Oral health survey of five-year-old and 12-year-old children attending special support schools 2014 Dental public health epidemiology programme Oral health survey of five-year-old and 12-year-old children attending special support schools 2014 A report on the prevalence and severity of dental decay Oral

More information

Drug and alcohol treatment in the North West of England 2008/09. Results from the National Drug Treatment Monitoring System (NDTMS)

Drug and alcohol treatment in the North West of England 2008/09. Results from the National Drug Treatment Monitoring System (NDTMS) Drug and alcohol treatment in the North West of England 2008/09 Results from the National Drug Treatment Monitoring System (NDTMS) Drug and alcohol treatment in the North West of England 2008/09 - Results

More information

Alcohol Treatment in Cheshire and Merseyside, 2010/11

Alcohol Treatment in Cheshire and Merseyside, 2010/11 Alcohol Treatment in Cheshire and Merseyside, 2010/11 Ayesha Hurst, Adam Marr, Mark Whitfield and Jim McVeigh July 2012 Acknowledgements The authors would like to thank the following people for their help

More information

CABINET PROCURING A SUBSTANCE MISUSE & COMMUNITY TREATMENT SERVICE IN RUTLAND

CABINET PROCURING A SUBSTANCE MISUSE & COMMUNITY TREATMENT SERVICE IN RUTLAND CABINET Report No: 105/2017 PUBLIC REPORT 16 May 2017 PROCURING A SUBSTANCE MISUSE & COMMUNITY TREATMENT SERVICE IN RUTLAND Report of the Director of Public Health Strategic Aim: Safeguarding Key Decision:

More information

National Cancer Registration and Analysis Service Be Clear on Cancer: National oesophago-gastric cancer awareness campaign (January/February 2015)

National Cancer Registration and Analysis Service Be Clear on Cancer: National oesophago-gastric cancer awareness campaign (January/February 2015) National Cancer Registration and Analysis Service Be Clear on Cancer: National oesophago-gastric cancer awareness campaign (January/February 2015) Interim evaluation results Version 1.0/ September 2016

More information

Dual Diagnosis. Themed Review Report 2006/07 SHA Regional Reports East Midlands

Dual Diagnosis. Themed Review Report 2006/07 SHA Regional Reports East Midlands Dual Diagnosis Themed Review Report 2006/07 SHA Regional Reports East Midlands Contents Foreword 1 Introduction 2 Recommendations 2 Themed Review 06/07 data 3 Additional information 13 Weighted population

More information

National Cancer Registration and Analysis Service s Cancer Analysis System (CAS)-SOP #1 Counting cancer cases

National Cancer Registration and Analysis Service s Cancer Analysis System (CAS)-SOP #1 Counting cancer cases National Cancer Registration and Analysis Service s Cancer Analysis System (CAS)-SOP #1 Counting cancer cases ublic Healt Engla About Public Health England Public Health England exists to protect and improve

More information

Showcasing the work of the Alcohol & Drugs Community of Improvement

Showcasing the work of the Alcohol & Drugs Community of Improvement Showcasing the work of the Alcohol & Drugs Community of Improvement Andy Collins, Public Health Co-ordinator, Doncaster Council Jez Mitchell, Public Health Principal, Wakefield Council Liz Butcher, HWB

More information

Consultation on revised threshold criteria. December 2016

Consultation on revised threshold criteria. December 2016 Consultation on revised threshold criteria December 2016 The text of this document (but not the logo and branding) may be reproduced free of charge in any format or medium, as long as it is reproduced

More information

Estimated number of people with hypertension. Significantly higher than the. Proportion. diagnosed with. hypertension

Estimated number of people with hypertension. Significantly higher than the. Proportion. diagnosed with. hypertension Hypertension profile Background Diagnosis and control of hypertension in * This profile compares with data for, authorities in the South East region and the Office for National Statistics (ONS) group of

More information

National Child Measurement Programme. Changes in children s body mass index between 2006/7 and 2014/15

National Child Measurement Programme. Changes in children s body mass index between 2006/7 and 2014/15 National Child Measurement Programme Changes in children s body mass index between 2006/7 and 2014/15 Version 1.0/ October 2016 Changes in Children s Body Mass Index btween 2006/7 and 2014/15 About Public

More information

Statistics from the Northern Ireland Drug Misuse Database: 1 April March 2011

Statistics from the Northern Ireland Drug Misuse Database: 1 April March 2011 Statistics from the Northern Ireland Drug Misuse Database: 1 April 2010 31 March 2011 This bulletin summarises information on people presenting to services with problem drug misuse and relates to the 12-month

More information

Substance Misuse (Drugs) Needs Assessment

Substance Misuse (Drugs) Needs Assessment Substance Misuse (Drugs) Needs Assessment 2013-14 23 rd May 2013 Contents Executive Summary...3 Gender, Age and Sexuality...9 Drug Profile...10 National Estimates of Prevalence of Opiate and Crack Users

More information

BARNSLEY METROPOLITAN BOROUGH COUNCIL

BARNSLEY METROPOLITAN BOROUGH COUNCIL BARNSLEY METROPOLITAN BOROUGH COUNCIL This matter is a Key Decision within the Council s definition and has been included in the relevant Forward Plan Report of the Executive Director (People) to Cabinet

More information

19. SUBSTANCE MISUSE INTRODUCTION

19. SUBSTANCE MISUSE INTRODUCTION 19. SUBSTANCE MISUSE INTRODUCTION Substance misuse is strongly associated with poverty and deprivation. Rates of substance misuse are particularly high in London compared with other regions. A range of

More information

Cambridgeshire Drug and Alcohol Action Team Needs Assessment

Cambridgeshire Drug and Alcohol Action Team Needs Assessment Cambridgeshire Drug and Alcohol Action Team Needs Assessment This report covers the: Adult drug needs assessment Adult alcohol needs assessment Young people s substance misuse needs assessment January

More information

Drug Misuse Research Division

Drug Misuse Research Division Drug Misuse Research Division Contents Occasional Paper p No. 12/ 9/ 2003 2004 Trends in treated problem drug use in the seven health board areas outside the Eastern Regional Health Authority, 1998 to

More information

Hypertension Profile. NHS High Weald Lewes Havens CCG. Background

Hypertension Profile. NHS High Weald Lewes Havens CCG. Background NHS High Weald Lewes Havens Background Hypertension Profile Diagnosis and control of in NHS High Weald Lewes Havens * This profile compares NHS High Weald Lewes Havens with data for, a group of similar

More information

Injecting Equipment Provision in Scotland Survey 2011/12

Injecting Equipment Provision in Scotland Survey 2011/12 Publication Report Injecting Equipment Provision in Scotland Survey 25 June 2013 An Official Statistics Publication for Scotland Contents Introduction... 2 Key points... 3 Results and Commentary... 4 1.

More information

Enter & View WDP Havering Drug and alcohol dependency services 11 October 2016

Enter & View WDP Havering Drug and alcohol dependency services 11 October 2016 Enter & View WDP Havering Drug and alcohol dependency services 11 October 2016 Healthwatch Havering is the operating name of Havering Healthwatch Limited A company limited by guarantee Registered in England

More information

National NHS patient survey programme Survey of people who use community mental health services 2014

National NHS patient survey programme Survey of people who use community mental health services 2014 National NHS patient survey programme Survey of people who use community mental health services The Care Quality Commission The Care Quality Commission (CQC) is the independent regulator of health and

More information

health impacts factsheet

health impacts factsheet Health services are central to tackling harm at the individual level among those with alcoholuse disorders and other conditions caused by harmful use of alcohol. The World Health Organisation (WHO) states

More information

Dumfries and Galloway Alcohol and Drug Partnership. Strategy

Dumfries and Galloway Alcohol and Drug Partnership. Strategy Dumfries and Galloway Alcohol and Drug Partnership Strategy 2017 2020 1 Contents Foreword...3 1. Introduction... 4 1.1 Background... 4 1.2 Aim... 4 1.3 National Context... 4 2. Strategic Priorities...

More information

Chronic Hepatitis C The Patient s Perspective

Chronic Hepatitis C The Patient s Perspective Chronic Hepatitis C The Patient s Perspective Authors: Josie Smith, Marion Lyons Page 1 of 12 October 2006 Status: Final Contents: Page: Executive Summary 3 Introduction 4 Methodology 4 Findings 5 Appendix

More information

Substance Misuse in Norfolk

Substance Misuse in Norfolk Needs Assessment 2013 Substance Misuse in Norfolk Clinical Commissioning Group Area Needs Assessments: North Norfolk By Claire Gummerson, Research and Information Officer for Norfolk Drug and Alcohol Action

More information

Trends in treated problem cannabis use in the seven health board areas outside the Eastern Regional Health Authority, 1998 to 2002

Trends in treated problem cannabis use in the seven health board areas outside the Eastern Regional Health Authority, 1998 to 2002 Drug Misuse Resear ch Divisio n Contents - Summary - Glossary of terms - Introduction - Methods - Analysis Trends in treated problem cannabis use in the seven health board areas outside the Eastern Regional

More information

London Chemsex Network Scoping meeting January 2017

London Chemsex Network Scoping meeting January 2017 London Chemsex Network Scoping meeting January 2017 Who are we? London Friend since 1972 Health & well-being Coming out, social groups, activity groups Mental health counselling Sexual health & HIV Prevention

More information

Outlook and Outcomes Fiscal Year 2011

Outlook and Outcomes Fiscal Year 2011 Baltimore Substance Abuse Systems, Inc. Outlook and Outcomes Fiscal Year 2011 Baltimore City Greg Warren, President Compiled July 2012 BSAS Outlook and Outcomes is the first edition of a planned annual

More information

NHS provider board membership and diversity survey: findings. October 2018

NHS provider board membership and diversity survey: findings. October 2018 NHS provider board membership and diversity survey: findings October 2018 1 Message from Dido Harding NHS boards have some of the most important roles in this country, ensuring through the strategy, accountability

More information

Quantifying Problematic Drug Use Within Liverpool and Sefton Drug [and Alcohol] Action Teams (2000/1 and 2001/2)

Quantifying Problematic Drug Use Within Liverpool and Sefton Drug [and Alcohol] Action Teams (2000/1 and 2001/2) Quantifying Problematic Drug Use Within Liverpool and Sefton Drug [and Alcohol] Action Teams (2000/1 and 2001/2) Capture-Recapture Analysis April 2004 Caryl Beynon, Jim McVeigh and Mark Bellis Centre for

More information

EMBARGOED NOT FOR RELEASE PRIOR TO AM WEDNESDAY OCTOBER

EMBARGOED NOT FOR RELEASE PRIOR TO AM WEDNESDAY OCTOBER Media Release National Drug and Alcohol Research Centre EMBARGOED NOT FOR RELEASE PRIOR TO 12.05 AM WEDNESDAY OCTOBER 14 2015 Crystal methamphetamine use increases by six per cent among people who inject

More information

Drugs Policy (including Alcohol)

Drugs Policy (including Alcohol) Frederick Bremer School Drugs Policy (including Alcohol) Person Responsible Review Frequency Policy First Issued Ms Emma Hillman 3 year review Last Reviewed September 2015 Agreed by LT on Does this policy

More information

Local Alcohol Profiles for England 2017 user guide

Local Alcohol Profiles for England 2017 user guide Local Alcohol Profiles for England 2017 user guide About Public Health England Public Health England s mission is to protect and improve the nation s health and to address inequalities through working

More information

Rebbecca Aust and Nicola Smith

Rebbecca Aust and Nicola Smith The Research, Development and Statistics Directorate exists to improve policy making, decision taking and practice in support of the Home Office purpose and aims, to provide the public and Parliament with

More information

Alcohol and Drug Commissioning Framework for Northern Ireland Consultation Questionnaire.

Alcohol and Drug Commissioning Framework for Northern Ireland Consultation Questionnaire. Alcohol and Drug Commissioning Framework for Northern Ireland 2013-16 Consultation Questionnaire. This questionnaire has been designed to help stakeholders respond to the above framework. Written responses

More information

Of those with dementia have a formal diagnosis or are in contact with specialist services. Dementia prevalence for those aged 80+

Of those with dementia have a formal diagnosis or are in contact with specialist services. Dementia prevalence for those aged 80+ Dementia Ref HSCW 18 Why is it important? Dementia presents a significant and urgent challenge to health and social care in County Durham, in terms of both numbers of people affected and the costs associated

More information

Justice Data Lab Re offending Analysis: Prisoners Education Trust

Justice Data Lab Re offending Analysis: Prisoners Education Trust Justice Data Lab Re offending Analysis: Prisoners Education Trust Summary This analysis assessed the impact on re offending of grants provided through the Prisoners Education Trust to offenders in custody

More information

Data mining Wales: The annual profile for substance misuse

Data mining Wales: The annual profile for substance misuse Data mining Wales: The annual profile for substance misuse 2016-17 Annual statistical report on alcohol and drug use on health, social care and education services in Wales through the life course About

More information

National Dementia Intelligence Network briefing

National Dementia Intelligence Network briefing Reasons why people with dementia are admitted to a general hospital in an emergency National Dementia Intelligence Network briefing Introduction In recent years there have been a number of national reports

More information

Primary Health Networks

Primary Health Networks Primary Health Networks Drug and Alcohol Treatment Activity Work Plan 2016-17 to 2018-19 Hunter New England & Central Coast Please note: This Activity Work Plan was developed in response to the HNECC PHN

More information

Substance use and misuse

Substance use and misuse An open learning programme for pharmacists and pharmacy technicians Substance use and misuse Educational solutions for the NHS pharmacy workforce DLP 160 Contents iii About CPPE open learning programmes

More information

Cardiovascular disease profile

Cardiovascular disease profile Background This chapter of the Cardiovascular disease profiles focuses on risk factors for cardiovascular disease and is produced by the National Cardiovascular Intelligence Network (NCVIN). The profiles

More information

Guideline scope Smoking cessation interventions and services

Guideline scope Smoking cessation interventions and services 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Topic NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline scope Smoking cessation interventions and services This guideline

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Centre for Clinical Practice SCOPE Clinical guideline title: Psychosis and schizophrenia in adults: treatment and management Quality standard title:

More information

NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia. Produced by: National Cardiovascular Intelligence Network (NCVIN)

NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia. Produced by: National Cardiovascular Intelligence Network (NCVIN) NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia Produced by: National Cardiovascular Intelligence Network (NCVIN) Date: August 2015 About Public Health England Public Health England

More information

WELSH GOVERNMENT RESPONSE TO RECOMMENDATIONS FROM THE HEALTH & SOCIAL CARE COMMITTEE: INQUIRY INTO NEW PSYCHOACTIVE SUBSTANCES

WELSH GOVERNMENT RESPONSE TO RECOMMENDATIONS FROM THE HEALTH & SOCIAL CARE COMMITTEE: INQUIRY INTO NEW PSYCHOACTIVE SUBSTANCES WELSH GOVERNMENT RESPONSE TO RECOMMENDATIONS FROM THE HEALTH & SOCIAL CARE COMMITTEE: INQUIRY INTO NEW PSYCHOACTIVE SUBSTANCES Recommendation 1 The Committee recommends that the Minister for Health and

More information

Summary of the Health Needs in Rugby Borough

Summary of the Health Needs in Rugby Borough Rugby Borough Summary of the Health Needs in Rugby Borough Domain Indicator Rugby Borough 2010 Trend Warwickshire England Data Communities Children's and young people Adult's health and lifestyle Disease

More information

Drug Related Deaths in Highland

Drug Related Deaths in Highland Drug Related Deaths in Highland Carolyn Hunter-Rowe Research and Intelligence Specialist August 2017 Highland Alcohol and Drugs Partnership Larch House, Stoneyfield Business Park, Inverness, IV2 7PA Website:

More information

The referral can be submitted by to:

The referral can be submitted by  to: Council Gateway Sunderland City Council Support Gateway is a single point of access to all Commissioned Supported Accommodation and Floating Support services. Referrals to the Gateway will be made by statutory

More information

NPS Toolkit in Prison England. Lessons for Young People and the Criminal Justice System

NPS Toolkit in Prison England. Lessons for Young People and the Criminal Justice System NPS Toolkit in Prison England. Lessons for Young People and the Criminal Justice System Kieran Lynch Criminal Justice Alcohol, drugs and tobacco division Public Health England Overview Background Prisons

More information

Mental Health Strategy. Easy Read

Mental Health Strategy. Easy Read Mental Health Strategy Easy Read Mental Health Strategy Easy Read The Scottish Government, Edinburgh 2012 Crown copyright 2012 You may re-use this information (excluding logos and images) free of charge

More information

The emerging cannabis treatment population

The emerging cannabis treatment population Loughborough University Institutional Repository The emerging cannabis treatment population This item was submitted to Loughborough University's Institutional Repository by the/an author. Citation: HAMILTON,

More information

HIV and injecting drug use in the UK

HIV and injecting drug use in the UK and injecting drug use in the UK Vivian Hope Dr Vivian Hope, IDU Team, & STI Department, Health Protection Services Colindale Injecting Drug Use Team, & STI Department, Centre for Infectious Disease Surveillance

More information

Drug Misuse Research Division

Drug Misuse Research Division Drug Misuse Research Division contents Occasional Paper No. 1/ 2002 - Background - NDTRS methodology - Treatment as an indicator of drug misuse - Treatment provision - Extent of the problem - Socio-demographic

More information

Analysis of Greater Glasgow & Clyde IEP Data John Campbell

Analysis of Greater Glasgow & Clyde IEP Data John Campbell Analysis of Greater Glasgow & Clyde IEP Data 2-2 John Campbell Contents Overview of the programme... 3 About this report... 4 Key points... 4 Drugs injected... 5 Drugs injected at transaction by unique

More information

The National perspective Public Health England s vision, mission and priorities

The National perspective Public Health England s vision, mission and priorities The National perspective Public Health England s vision, mission and priorities Dr Ann Hoskins Director Children, Young People and Families Public Health England May 2013 Mission Public Health England

More information

GUMCAD STI Surveillance System (DCB0139) Implementation Guidance

GUMCAD STI Surveillance System (DCB0139) Implementation Guidance GUMCAD STI Surveillance System (DCB0139) Implementation Guidance About Public Health England Public Health England exists to protect and improve the nation s health and wellbeing, and reduce health inequalities.

More information

National Drug and Alcohol Treatment Waiting Times Report

National Drug and Alcohol Treatment Waiting Times Report Publication Report National Drug and Alcohol Treatment Waiting Times Report October December 2016 Publication Date 28 March 2017 A National Statistics Publication for Scotland Contents Introduction...

More information

Men Behaving Badly? Ten questions council scrutiny can ask about men s health

Men Behaving Badly? Ten questions council scrutiny can ask about men s health Men Behaving Badly? Ten questions council scrutiny can ask about men s health Contents Why scrutiny of men s health is important 03 Ten questions to ask about men s health 04 Conclusion 10 About the Centre

More information

Northumberland, Tyne and Wear NHS Foundation Trust. Board of Directors Meeting

Northumberland, Tyne and Wear NHS Foundation Trust. Board of Directors Meeting Agenda item Northumberland, Tyne and Wear NHS Foundation Trust Board of Directors Meeting Meeting Date: 29th November 2017 Title and Author of Paper: National CQC Community Mental Health Survey & National

More information

Attachment A Brighton & Hove City Council

Attachment A Brighton & Hove City Council Attachment A Brighton & Hove City Council Young people and smoking cessation: a pack for community pharmacies providing smoking cessation to under 16 year olds in Brighton and Hove Susan Stewart 11/25/2016

More information

Page. Drug-Related Deaths Summit 2015

Page. Drug-Related Deaths Summit 2015 Page Drug-Related Deaths Summit 2015 Page 2 Key messages The availability of accurate, timely and easily accessible data is important in order to make the appropriate adjustments to policy and practice

More information

National Drug and Alcohol Treatment Waiting Times

National Drug and Alcohol Treatment Waiting Times National Drug and Alcohol Treatment Waiting Times 1 October 31 December 2017 Publication date 27 March 2018 A National Statistics publication for Scotland This is a National Statistics Publication National

More information

1. RE-COMMISSIONING OF DRUG AND ALCOHOL TREATMENT AND RECOVERY SERVICES

1. RE-COMMISSIONING OF DRUG AND ALCOHOL TREATMENT AND RECOVERY SERVICES Cabinet Member Decision 7 August 2014 1. RE-COMMISSIONING OF DRUG AND ALCOHOL TREATMENT AND RECOVERY SERVICES Relevant Cabinet Member Relevant Officer Recommendation Mr M J Hart Director of Adult Services

More information